Healthcare Provider Details

I. General information

NPI: 1598917841
Provider Name (Legal Business Name): SUSAN RONAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BEAR RIDGE RD
PLEASANTVILLE NY
10570-2543
US

IV. Provider business mailing address

39 CRADLE ROCK RD
POUND RIDGE NY
10576-2210
US

V. Phone/Fax

Practice location:
  • Phone: 917-902-8781
  • Fax:
Mailing address:
  • Phone: 917-902-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number010993-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: