Basic Information
| Provider Information | |||||||||
| NPI: | 1902246622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | ALLIE | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 AVENUE A STE C | ||||||||
| Address2: | |||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982902961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605630629 | ||||||||
| FaxNumber: | 3605630693 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 AVENUE A STE C | ||||||||
| Address2: | |||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982902961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605630629 | ||||||||
| FaxNumber: | 3605630693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172M00000X | MA 60328787 | WA | Y | Other Service Providers | Mechanotherapist |
No ID Information.