Jeanette T. Barrack, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11265 Issued in CA

Practice address

5360 Jackson Dr
La Mesa, CA 91942-6002

Phone

(616) 667-7000

Fax

(619) 667-4315

NPI assigned

May 11, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Deason IncGroup PAC ID 6305808718, 3 clinicians

California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment Care Compare group NPD
• Deason Inc

  • Physical Therapist
  • Spring Valley, CA
  • NPI 1205903861
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1295940369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5360 JACKSON DR STE 110",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423012",
            "telephone_number": "619-667-7000",
            "fax_number": "619-667-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5360 JACKSON DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919426002",
            "telephone_number": "616-667-7000",
            "fax_number": "619-667-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRACK",
        "first_name": "JEANETTE",
        "middle_name": "T.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "11265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1023103330",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT11265",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luke Barnard, MD
• Gregory Devon Barnes
• David Leonard Baron, M.D.
• Kristina Marie Baronian
• Herbert Joseph Barrack, C.P.O.
• Jorge Aurelio Barrera, MD
• Sharla Marlene Barry, RN, MFT
• Kerry L Barth, PSYD, MFT
• John S Bartholow, PH.D.
• Patricia A Bartholow, LCSW

• Physical Therapist in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.