Provider Demographics
NPI:1073670949
Name:GRIFFIN, SUSAN M (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:KOSTECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1989
Mailing Address - Country:US
Mailing Address - Phone:716-774-8424
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3224
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019403-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist