Provider Demographics
NPI:1134420151
Name:HALTERMANN, DEIRDRE SHERIDAN (PT)
Entity type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:SHERIDAN
Last Name:HALTERMANN
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 494
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12496-0494
Mailing Address - Country:US
Mailing Address - Phone:518-734-5481
Mailing Address - Fax:
Practice Address - Street 1:159 W MAIN ST
Practice Address - Street 2:CYR CENTER
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1027
Practice Address - Country:US
Practice Address - Phone:607-652-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06669-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics