Provider Demographics
NPI:1750684585
Name:MANTARING-HARRIS, SUZETTE (PT)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:MANTARING-HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1445 E PUTNAM AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1379
Mailing Address - Country:US
Mailing Address - Phone:203-983-5748
Mailing Address - Fax:203-869-4420
Practice Address - Street 1:1445 E PUTNAM AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1379
Practice Address - Country:US
Practice Address - Phone:203-983-5748
Practice Address - Fax:203-869-4420
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic