Provider Demographics
NPI:1548562176
Name:SIESS-MANFRE, SUZANNE RUTH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RUTH
Last Name:SIESS-MANFRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 LORRAINE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1834
Mailing Address - Country:US
Mailing Address - Phone:516-616-0096
Mailing Address - Fax:
Practice Address - Street 1:1132 LORRAINE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1834
Practice Address - Country:US
Practice Address - Phone:516-616-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21631225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant