Provider Demographics
NPI:1467677591
Name:RUSWICK, SUSAN MCKERNAN (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MCKERNAN
Last Name:RUSWICK
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 1:508 N AURORA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3711
Mailing Address - Country:US
Mailing Address - Phone:607-273-7755
Mailing Address - Fax:
Practice Address - Street 1:1001 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3342
Practice Address - Country:US
Practice Address - Phone:607-277-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010009-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist