Provider Demographics
NPI:1598917841
Name:RONAN, SUSAN (PT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:RONAN
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 1:39 CRADLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-2210
Mailing Address - Country:US
Mailing Address - Phone:917-902-8781
Mailing Address - Fax:
Practice Address - Street 1:600 BEAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2543
Practice Address - Country:US
Practice Address - Phone:917-902-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010993-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics