Provider Demographics
NPI:1518504588
Name:SURPRENANT, ADRIANA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MARIE
Last Name:SURPRENANT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:MARIE
Other - Last Name:BENKWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 RICHBELL RD APT A4
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3210
Mailing Address - Country:US
Mailing Address - Phone:315-269-6721
Mailing Address - Fax:
Practice Address - Street 1:785 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2523
Practice Address - Country:US
Practice Address - Phone:914-597-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist