Provider Demographics
NPI:1417013376
Name:PARKER, SUSAN C (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 LINDEN OAKS STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2841
Mailing Address - Country:US
Mailing Address - Phone:585-264-9440
Mailing Address - Fax:585-264-1489
Practice Address - Street 1:200 LINDEN OAKS STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2841
Practice Address - Country:US
Practice Address - Phone:585-264-9440
Practice Address - Fax:585-264-1489
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008186-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0438Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER