Basic Information
| Provider Information | |||||||||
| NPI: | 1174585343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | SPENCE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 PROFESSIONAL PLZ STE 110 | ||||||||
| Address2: | |||||||||
| City: | REXBURG | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834402049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0823599570 | ||||||||
| FaxNumber: | 2083599580 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | ASHTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834205105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083599570 | ||||||||
| FaxNumber: | 2083599580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT-1725 | ID | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | 1725 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.