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General NPI Number Information
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NPI Number | 1134420151
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Entity Type | Individual
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Provider Name | DEIRDRE SHERIDAN HALTERMANN P.T.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 159 W MAIN ST CYR CENTER
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City | STAMFORD
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State | NY
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Zip | 12167-1027
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Country | US
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Telephone | 607-652-1200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | WINDHAM
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State | NY
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Zip | 12496-0494
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Country | US
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Telephone | 518-734-5481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 06669-1
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License Number State | NY
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