Provider Demographics
NPI:1598078818
Name:CHURCHILL, ANNA-BARBARA B (MA, PT)
Entity Type:Individual
Prefix:MS
First Name:ANNA-BARBARA
Middle Name:B
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AMHERST CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2001
Mailing Address - Country:US
Mailing Address - Phone:516-678-3497
Mailing Address - Fax:
Practice Address - Street 1:12 AMHERST CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2001
Practice Address - Country:US
Practice Address - Phone:516-678-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015498-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist