Provider Demographics
NPI:1184109266
Name:BARNA, KYLE (ATC, PTA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BARNA
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 LAKE SPANGENBERG RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-5005
Mailing Address - Country:US
Mailing Address - Phone:570-351-7107
Mailing Address - Fax:
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-961-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0044212255A2300X
PATE011527225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer