Provider Demographics
NPI:1265430615
Name:BARRY, JOANNE M (PT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:BARRY
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 1:718 OLD LIVERPOOL RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6035
Mailing Address - Country:US
Mailing Address - Phone:315-457-7005
Mailing Address - Fax:315-457-7214
Practice Address - Street 1:718 OLD LIVERPOOL RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6035
Practice Address - Country:US
Practice Address - Phone:315-457-7005
Practice Address - Fax:315-457-7214
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003540-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5478Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER