Provider Demographics
NPI:1023598992
Name:SOMERVILLE, IRENE (DPT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 N GREENBUSH RD STE 3
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9424
Mailing Address - Country:US
Mailing Address - Phone:518-326-3771
Mailing Address - Fax:518-776-1070
Practice Address - Street 1:476 N GREENBUSH RD STE 3
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9424
Practice Address - Country:US
Practice Address - Phone:518-326-3771
Practice Address - Fax:518-776-1070
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist