Provider Demographics
NPI:1700038056
Name:FOX, SUSAN IDA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:IDA
Last Name:FOX
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 1:17 CARILLON RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-1027
Mailing Address - Country:US
Mailing Address - Phone:845-278-9221
Mailing Address - Fax:
Practice Address - Street 1:17 CARILLON RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1027
Practice Address - Country:US
Practice Address - Phone:845-278-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics