Healthcare Provider Details

I. General information

NPI: 1992809222
Provider Name (Legal Business Name): SUSAN M KANTOR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 ACME ROAD
FRANKFORT NY
13340-3504
US

IV. Provider business mailing address

4266 ACME ROAD
FRANKFORT NY
13340-3504
US

V. Phone/Fax

Practice location:
  • Phone: 315-894-3050
  • Fax: 315-895-0915
Mailing address:
  • Phone: 315-894-3050
  • Fax: 315-895-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0065881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: