Basic Information
| Provider Information | |||||||||
| NPI: | 1033249347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARNETT | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | BETHUNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 831 UNIVERSITY BLVD, EAST | ||||||||
| Address2: | SUITE #14 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014453191 | ||||||||
| FaxNumber: | 3014453198 | ||||||||
| Practice Location | |||||||||
| Address1: | 2185 NORTHLAKE PARKWAY | ||||||||
| Address2: | BUILDING 8, SUITE 100 | ||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704936360 | ||||||||
| FaxNumber: | 3014453198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A2363 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2306603805 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | PTA003179 | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.