Provider Demographics
NPI:1922067065
Name:BURGESS, BARBARA (PT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1182 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE LL02
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1026
Mailing Address - Country:US
Mailing Address - Phone:518-220-9705
Mailing Address - Fax:518-220-9651
Practice Address - Street 1:1182 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE LL02
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1026
Practice Address - Country:US
Practice Address - Phone:518-220-9705
Practice Address - Fax:518-220-9651
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0094311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01940743Medicaid
0004902130008OtherBLUE SHIELD
433960OtherMVP
QA3083OtherBLUE CROSS
0004902130008OtherBLUE SHIELD
NY01940743Medicaid