Provider Demographics
NPI:1811062391
Name:HAWLEY, SUSAN S (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:HAWLEY
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 1:540 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1613
Mailing Address - Country:US
Mailing Address - Phone:585-427-7190
Mailing Address - Fax:585-427-8827
Practice Address - Street 1:540 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1613
Practice Address - Country:US
Practice Address - Phone:585-427-7190
Practice Address - Fax:585-427-2287
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0037661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3658Medicare ID - Type Unspecified