Individual
BETTY ANN M DUBACHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
43 RED POND RD, PETERSBURG, NY 12138-5916
(518) 687-4612
Mailing address
43 RED POND RD, PETERSBURG, NY 12138-5916
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
000864-1
NY
225200000X
Physical Therapy Assistant
000864-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000864-1
NYSDE
NY
01
—
9366726
NYSDE
NY
Enumeration date
08/16/2018
Last updated
08/16/2018
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