Provider Demographics
NPI:1104030360
Name:DESERRE, CHARLENE MARGARET (PT)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARGARET
Last Name:DESERRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5220
Mailing Address - Country:US
Mailing Address - Phone:845-223-5852
Mailing Address - Fax:
Practice Address - Street 1:3 SUMMIT CT
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1334
Practice Address - Country:US
Practice Address - Phone:845-896-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist