MEDICARE: MS. SUSANNE ELIZABETH CALLAN-HARRIS PT MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	006753-1	NY

General Provider Information

NPI Number	:	1396846887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSANNE ELIZABETH CALLAN-HARRIS PT MS

Provider Business Mailing Address
First Line	:	1328 UNIVERSITY AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1622
Country	:	US
Telephone Number	:	585-482-5060
Fax Number	:	585-482-7982

Provider Business Practice Location Address
First Line	:	1328 UNIVERSITY AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1622
Country	:	US
Telephone Number	:	585-482-5060
Fax Number	:	585-482-7982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	10/03/2017

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