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1093820581 NPI number — SUSAN STEARNS MEAD PT

NPI Number: 1093820581
Health Care Provider/Practitioner: SUSAN STEARNS MEAD PT

Information about “1093820581” NPI (SUSAN STEARNS MEAD PT) exists in 1093820581 in HTML format HTML  |  1093820581 in plain Text format TXT  |  1093820581 in PDF (Portable Document Format) PDF  |  1093820581 in an XML format XML  formats.

NPI Number : 1093820581 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093820581",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MEAD",
    "FirstName": "SUSAN",
    "MiddleName": "STEARNS",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STEARNS",
    "OtherFirstName": "SUSAN",
    "OtherMiddleName": "KAY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "219 W LINCOLN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ITHACA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14850",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "607-272-5320",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11919 HALM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORNING",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14830",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "607-738-2837",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/21/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "12/27/2006",
    "NPIReactivationDate": "04/04/2007",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "0099361",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "0033631",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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