Provider Demographics
NPI:1245715762
Name:DE OLIVEIRA SA LATYKI, BARBARA EDEN
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:EDEN
Last Name:DE OLIVEIRA SA LATYKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:EDEN
Other - Last Name:DE OLIVEIRA SA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 BERGEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2112
Mailing Address - Country:US
Mailing Address - Phone:862-242-6039
Mailing Address - Fax:
Practice Address - Street 1:7033 COMMONWEALTH AVE STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220-2831
Practice Address - Country:US
Practice Address - Phone:904-378-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01806500225100000X
FLPT35095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist