Provider Demographics
NPI:1790901478
Name:HEADLEY, BARBARA EYVONNE (PT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:EYVONNE
Last Name:HEADLEY
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:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-0015
Mailing Address - Country:US
Mailing Address - Phone:860-257-7448
Mailing Address - Fax:860-257-9574
Practice Address - Street 1:2080 SILAS DEANE HWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2334
Practice Address - Country:US
Practice Address - Phone:860-257-7448
Practice Address - Fax:860-257-9574
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist