Provider Demographics
NPI:1093232704
Name:PETIT-FRERE, PHEBA SUSAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:PHEBA
Middle Name:SUSAN
Last Name:PETIT-FRERE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:PHEBA
Other - Middle Name:SUSAN
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:24 BUTLER PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1009
Mailing Address - Country:US
Mailing Address - Phone:914-602-8537
Mailing Address - Fax:
Practice Address - Street 1:450 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2400
Practice Address - Country:US
Practice Address - Phone:914-686-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist