Healthcare Provider Details

I. General information

NPI: 1831356252
Provider Name (Legal Business Name): SUSAN BREZNAK-HONEYCHURCH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CENTRAL AVE
FREDONIA NY
14063-1136
US

IV. Provider business mailing address

150 CENTRAL AVENUE
FREDONIA NY
14063-1136
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-2499
  • Fax: 716-366-1667
Mailing address:
  • Phone: 716-366-2499
  • Fax: 716-366-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007385-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: