Provider Demographics
NPI:1245217736
Name:BARRY, MARCI (DPT)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:SIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:18 HAMILTON PL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1915
Mailing Address - Country:US
Mailing Address - Phone:516-454-6387
Mailing Address - Fax:516-454-6303
Practice Address - Street 1:913 N BROADWAY
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2364
Practice Address - Country:US
Practice Address - Phone:516-454-6387
Practice Address - Fax:516-454-6303
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP1901Medicare PIN
NYQP1901Medicare UPIN
NYQP1901Medicare Oscar/Certification