Provider Demographics
NPI:1831225333
Name:GOERCKE, KAREN BARBARA (PT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:BARBARA
Last Name:GOERCKE
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 1:3 DAMARIS CT
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1763
Mailing Address - Country:US
Mailing Address - Phone:631-472-2482
Mailing Address - Fax:631-472-5419
Practice Address - Street 1:3 DAMARIS CT
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1763
Practice Address - Country:US
Practice Address - Phone:631-472-2482
Practice Address - Fax:631-472-5419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005674-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist