MEDICARE: MS. HONORE SUSAN SIMMONS PETRASEK PHYSICAL THERAPIST

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	171W00000X	Contractor	011621	NY

General Provider Information

NPI Number	:	1992830780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HONORE SUSAN SIMMONS PETRASEK PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	27 CATHERINE ST
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-1318
Country	:	US
Telephone Number	:	631-261-9145
Fax Number	:	631-261-9145

Provider Business Practice Location Address
First Line	:	27 CATHERINE ST
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-1318
Country	:	US
Telephone Number	:	631-261-9145
Fax Number	:	631-261-9145

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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