Provider Demographics
NPI:1427484823
Name:DETURK, BARBARA W (PT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:W
Last Name:DETURK
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 1:162 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3408
Mailing Address - Country:US
Mailing Address - Phone:631-821-6474
Mailing Address - Fax:631-821-6474
Practice Address - Street 1:162 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3408
Practice Address - Country:US
Practice Address - Phone:631-821-6474
Practice Address - Fax:631-821-6474
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006011-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist