Provider Demographics
NPI:1720815707
Name:BARNES, DOUG (ATC LAT)
Entity type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 LONESOME STAR TRL
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-5119
Mailing Address - Country:US
Mailing Address - Phone:817-657-8474
Mailing Address - Fax:
Practice Address - Street 1:1350 EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-1145
Practice Address - Country:US
Practice Address - Phone:817-698-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT16312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer