Provider Demographics
NPI:1548415540
Name:CRANE, SUZANNE SOPHIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:SOPHIA
Last Name:CRANE
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 1:985 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1706
Mailing Address - Country:US
Mailing Address - Phone:516-374-6299
Mailing Address - Fax:
Practice Address - Street 1:6325 DRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1964
Practice Address - Country:US
Practice Address - Phone:718-639-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017666-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics