Basic Information
| Provider Information | |||||||||
| NPI: | 1063410330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 120 | ||||||||
| Address2: | |||||||||
| City: | WESTCLIFFE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812520120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197832380 | ||||||||
| FaxNumber: | 7197832377 | ||||||||
| Practice Location | |||||||||
| Address1: | 704 EDWARDS ST | ||||||||
| Address2: | |||||||||
| City: | WESTCLIFFE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812528588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197832380 | ||||||||
| FaxNumber: | 7197832377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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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 | 225100000X | 7205 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 650024367 | 01 | RAILROAD MEDICARE | OTHER | 841090521007 | 01 | CO | ROCKY MTN HEALTH PLANS | OTHER |