Provider Demographics
NPI:1093820581
Name:MEAD, SUSAN STEARNS (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:STEARNS
Last Name:MEAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:STEARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-272-5320
Mailing Address - Fax:
Practice Address - Street 1:11919 HALM RD
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-738-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:2006-12-27
Deactivation Code:
Reactivation Date:2007-04-04
Provider Licenses
StateLicense IDTaxonomies
NY0099361225700000X
NY0033631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I88749Medicare UPIN