Basic Information
| Provider Information | |||||||||
| NPI: | 1427068816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARIBEAU | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13151 MAGISTERIAL DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871236 | ||||||||
| FaxNumber: | 5025870318 | ||||||||
| Practice Location | |||||||||
| Address1: | 13151 MAGISTERIAL DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871236 | ||||||||
| FaxNumber: | 5025870318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 002822 | 01 | KY | STATE ID | OTHER |