Provider Demographics
NPI:1356369649
Name:AHEARN, PATRICIA SCORDINO (MPT, MTC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SCORDINO
Last Name:AHEARN
Suffix:
Gender:F
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N BROADWAY
Mailing Address - Street 2:BUILDING 1 UNIT 2
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1640
Mailing Address - Country:US
Mailing Address - Phone:914-946-4654
Mailing Address - Fax:
Practice Address - Street 1:55 N BROADWAY
Practice Address - Street 2:BUILDING 1 UNIT 2
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1640
Practice Address - Country:US
Practice Address - Phone:914-946-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021184-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021184-1OtherPT LICENSE