Basic Information
| Provider Information | |||||||||
| NPI: | 1972542744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIETER-BARKER | ||||||||
| FirstName: | DEBORAH | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700C LAKE ST | ||||||||
| Address2: | OFFICE COURT | ||||||||
| City: | RAMSEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074461372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019627454 | ||||||||
| FaxNumber: | 2019627455 | ||||||||
| Practice Location | |||||||||
| Address1: | 700C LAKE ST | ||||||||
| Address2: | OFFICE COURT | ||||||||
| City: | RAMSEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074461372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019627454 | ||||||||
| FaxNumber: | 2019627455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | QA00454300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.