MEDICARE: MS. SUSAN H FETTO PT

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	003893	NY

General Provider Information

NPI Number	:	1710961537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN H FETTO PT

Provider Business Mailing Address
First Line	:	104 E 40TH ST
Second Line	:	908
City	:	NEW YORK
State	:	NY
Zip	:	10016-1801
Country	:	US
Telephone Number	:	212-370-4540
Fax Number	:	212-682-8206

Provider Business Practice Location Address
First Line	:	104 E 40TH ST
Second Line	:	908
City	:	NEW YORK
State	:	NY
Zip	:	10016-1801
Country	:	US
Telephone Number	:	212-370-4540
Fax Number	:	212-682-8206

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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