Provider Demographics
NPI:1447496690
Name:MINNEROP, KATHRYN SUSAN (RPT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SUSAN
Last Name:MINNEROP
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1302
Mailing Address - Country:US
Mailing Address - Phone:845-365-3488
Mailing Address - Fax:845-365-3488
Practice Address - Street 1:80 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1302
Practice Address - Country:US
Practice Address - Phone:845-365-3488
Practice Address - Fax:845-365-3488
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPT-002974-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist