Provider Demographics
NPI:1396172094
Name:READ, SUSAN MARIE
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:READ
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 1:1016 SOUTHERN PINES DR
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1807
Mailing Address - Country:US
Mailing Address - Phone:607-748-3528
Mailing Address - Fax:
Practice Address - Street 1:913 CASE DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3936
Practice Address - Country:US
Practice Address - Phone:607-760-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004915-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant