Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 06669-1 | NY |
NPI | 1134420151 |
---|---|
Provider Name | Mrs. Deirdre Sheridan Haltermann |
First Address | Windham, NY 12496-0494 |
Second Address | Stamford, NY 12167-1027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2010 |
Last Update Date | 08/11/2010 |