Provider Demographics
NPI:1982721163
Name:PHILIP, SUSAN ANN
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:PHILIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N PARK TER
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2140
Mailing Address - Country:US
Mailing Address - Phone:845-268-8256
Mailing Address - Fax:845-267-8256
Practice Address - Street 1:29 N PARK TER
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2140
Practice Address - Country:US
Practice Address - Phone:845-268-8256
Practice Address - Fax:845-267-8256
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist