Provider Demographics
NPI:1639356561
Name:OBERMEYER, CARLI J (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARLI
Middle Name:J
Last Name:OBERMEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CARLI
Other - Middle Name:J
Other - Last Name:VANWAGENEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4057
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:61 EMERALD PL
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:NY
Practice Address - Zip Code:12775-6049
Practice Address - Country:US
Practice Address - Phone:845-703-6999
Practice Address - Fax:845-703-6297
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400052982Medicare PIN