Provider Demographics
NPI:1447552864
Name:GEEVARGHESE, SUSAN S (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:GEEVARGHESE
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 1:1790 FRONT ST
Mailing Address - Street 2:UNIT 24
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2400
Mailing Address - Country:US
Mailing Address - Phone:516-385-6010
Mailing Address - Fax:
Practice Address - Street 1:11515 101ST AVE
Practice Address - Street 2:HEARTSHARE FIRST STEP EARLY CHILDHOOD CENTER
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1247
Practice Address - Country:US
Practice Address - Phone:718-441-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021043-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics