Provider Demographics
NPI:1346325354
Name:DOUGLAS, BARBARA V (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:V
Last Name:DOUGLAS
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 1:1783A MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4537
Mailing Address - Country:US
Mailing Address - Phone:212-996-3303
Mailing Address - Fax:212-996-9686
Practice Address - Street 1:1783A MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4537
Practice Address - Country:US
Practice Address - Phone:212-996-3303
Practice Address - Fax:212-996-9686
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52572Medicare ID - Type UnspecifiedPROVIDER NUMBER