Provider Demographics
NPI:1326134990
Name:BARRY, CATHERINE MARY (PT)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:BARRY
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 1:4365 DEEP HOLE DR
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952
Mailing Address - Country:US
Mailing Address - Phone:631-298-1281
Mailing Address - Fax:
Practice Address - Street 1:MAXIMUM PERFORMANCE PHYSICAL THERAPY 185 OLD COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-208-4443
Practice Address - Fax:631-208-4448
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0124261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCB0Q07B030Medicare PIN
Q07B03Medicare ID - Type Unspecified