Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 62-038502 | NY |
NPI | 1043617004 |
---|---|
Provider Name | Theresa C Barry |
First Address | Macedon, NY 14502-8943 |
Second Address | Macedon, NY 14502-8943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2014 |
Last Update Date | 19/11/2014 |