Provider Demographics
NPI:1578873956
Name:BARRIOS, DIANA (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BARRIOS
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 1:18016 WEXFORD TER
Mailing Address - Street 2:SUITE CC
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18016 WEXFORD TER
Practice Address - Street 2:SUITE CC
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3000
Practice Address - Country:US
Practice Address - Phone:718-658-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2020-02-19
Deactivation Date:2012-02-22
Deactivation Code:
Reactivation Date:2020-02-19
Provider Licenses
StateLicense IDTaxonomies
NY031712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist