Basic Information
| Provider Information | |||||||||
| NPI: | 1326108374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | DPT, OCS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 S GOVERNORS AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199046901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027304800 | ||||||||
| FaxNumber: | 3027308040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 S GOVERNORS AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199046901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027304800 | ||||||||
| FaxNumber: | 3027308040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 11/01/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0000614 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1000028606 | 05 | DE | MEDICAID |