Provider Demographics
NPI:1831356252
Name:BREZNAK-HONEYCHURCH, SUSAN (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:BREZNAK-HONEYCHURCH
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 1:150 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1136
Mailing Address - Country:US
Mailing Address - Phone:716-366-2499
Mailing Address - Fax:716-366-1667
Practice Address - Street 1:150 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1136
Practice Address - Country:US
Practice Address - Phone:716-366-2499
Practice Address - Fax:716-366-1667
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007385-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist