Provider Demographics
NPI:1942430517
Name:BARRETT, DUSTIN ROBERT (PT)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:ROBERT
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 LAKE RIDGE SQ
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2999
Mailing Address - Country:US
Mailing Address - Phone:276-971-2678
Mailing Address - Fax:
Practice Address - Street 1:1500 W ELK AVE STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2655
Practice Address - Country:US
Practice Address - Phone:423-543-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021100Medicaid