Provider Demographics
NPI:1174585343
Name:BARKER, GREGORY SPENCE (DPT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SPENCE
Last Name:BARKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:36 PROFESSIONAL PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2049
Mailing Address - Country:US
Mailing Address - Phone:082-359-9570
Mailing Address - Fax:208-359-9580
Practice Address - Street 1:700 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:ID
Practice Address - Zip Code:83420-5105
Practice Address - Country:US
Practice Address - Phone:208-359-9570
Practice Address - Fax:208-359-9580
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1725208100000X
NV1725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502079Medicaid
NV100502079Medicaid
V38766Medicare UPIN