Healthcare Provider Details

I. General information

NPI: 1346582350
Provider Name (Legal Business Name): JOANNE MALY BARNEVELD PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8022 STATE ROUTE 12
BARNEVELD NY
13304-2512
US

IV. Provider business mailing address

8022 STATE ROUTE 12
BARNEVELD NY
13304-2512
US

V. Phone/Fax

Practice location:
  • Phone: 315-896-5100
  • Fax: 315-896-5102
Mailing address:
  • Phone: 315-896-5100
  • Fax: 315-896-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010569
License Number StateNY

VIII. Authorized Official

Name: JOANNE MALY
Title or Position: OWNER
Credential: DPT
Phone: 315-896-5100