Provider Demographics
NPI:1609925759
Name:DRAKE, BARBARA M (MPT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:M
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-3102
Mailing Address - Country:US
Mailing Address - Phone:315-232-2225
Mailing Address - Fax:315-232-2800
Practice Address - Street 1:70 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-3102
Practice Address - Country:US
Practice Address - Phone:315-232-2225
Practice Address - Fax:315-232-2800
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025390-12251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9563Medicare ID - Type Unspecified