Provider Demographics
NPI:1578778478
Name:BARNES, DIANE DENEKA (PT, MS, PCS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:DENEKA
Last Name:BARNES
Suffix:
Gender:F
Credentials:PT, MS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7910
Mailing Address - Country:US
Mailing Address - Phone:973-632-7203
Mailing Address - Fax:
Practice Address - Street 1:39 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7910
Practice Address - Country:US
Practice Address - Phone:973-632-7203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA003667002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics