Provider Demographics
NPI:1891275012
Name:DUBACHER, BETTY ANN M (PTA)
Entity Type:Individual
Prefix:
First Name:BETTY ANN
Middle Name:M
Last Name:DUBACHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RED POND RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12138-5916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 RED POND RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:NY
Practice Address - Zip Code:12138-5916
Practice Address - Country:US
Practice Address - Phone:518-687-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000864-1225200000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000864-1OtherNYSDE
NY9366726OtherNYSDE