Provider Demographics
NPI:1992734719
Name:BARRETT, JENNIFER LYNN (MPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:HIBL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:16560 WEDGE PKWY
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3318
Mailing Address - Country:US
Mailing Address - Phone:775-384-1400
Mailing Address - Fax:775-384-1367
Practice Address - Street 1:16560 WEDGE PKWY
Practice Address - Street 2:SUITE 200A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3318
Practice Address - Country:US
Practice Address - Phone:775-384-1400
Practice Address - Fax:775-384-1367
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27806225100000X
NV2559225100000X
CA27806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17918Medicare UPIN