Provider Demographics
NPI:1710064514
Name:DEMATTEO, BARBARA B (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:DEMATTEO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:BURRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MOORE FARM RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 ISLAND ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3528
Practice Address - Country:US
Practice Address - Phone:603-358-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11092251P0200X
VT04000008402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30390108Medicaid