Provider Demographics
NPI:1184990707
Name:BACUS, JANETH (PT)
Entity type:Individual
Prefix:MS
First Name:JANETH
Middle Name:
Last Name:BACUS
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 1:255 LEXINGTON AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1205
Mailing Address - Country:US
Mailing Address - Phone:551-689-6272
Mailing Address - Fax:
Practice Address - Street 1:201 WARREN STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282
Practice Address - Country:US
Practice Address - Phone:212-571-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62-0299842251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics