Provider Demographics
NPI:1316208150
Name:DECKER, KARLY S (PT)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:S
Last Name:DECKER
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:PO BOX 11471
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0471
Mailing Address - Country:US
Mailing Address - Phone:518-373-7967
Mailing Address - Fax:518-373-0735
Practice Address - Street 1:1 BARNEY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-5843
Practice Address - Country:US
Practice Address - Phone:518-373-7967
Practice Address - Fax:518-373-0735
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist