Provider Demographics
NPI:1811137334
Name:DEE-LAGO, BARBARA SHIELA (DPT)
Entity type:Individual
Prefix:
First Name:BARBARA SHIELA
Middle Name:
Last Name:DEE-LAGO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BARBARA SHIELA
Other - Middle Name:
Other - Last Name:DEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4 EGBERT PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3827
Mailing Address - Country:US
Mailing Address - Phone:718-909-4898
Mailing Address - Fax:718-720-5133
Practice Address - Street 1:4 EGBERT PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3827
Practice Address - Country:US
Practice Address - Phone:718-909-4898
Practice Address - Fax:718-720-5133
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist