Healthcare Provider Details

I. General information

NPI: 1891312328
Provider Name (Legal Business Name): SUSAN MARIE KRONK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE BORDONARO PT

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E MILLTOWN RD
WOOSTER OH
44691-1331
US

IV. Provider business mailing address

959 YESTERDAY LN
MEDINA OH
44256-3542
US

V. Phone/Fax

Practice location:
  • Phone: 330-287-4500
  • Fax:
Mailing address:
  • Phone: 216-402-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9418
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: