Provider Demographics
NPI:1427021088
Name:STEWART, SUZANNE MARIA (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:25 LAKE AVE
Mailing Address - City:LYNDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14098
Mailing Address - Country:US
Mailing Address - Phone:585-765-2562
Mailing Address - Fax:585-765-2198
Practice Address - Street 1:25 LAKE AVE
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14098
Practice Address - Country:US
Practice Address - Phone:585-765-2562
Practice Address - Fax:585-765-2198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0167011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P48090Medicare UPIN
NYCC8526Medicare ID - Type Unspecified