Provider Demographics
NPI:1871926667
Name:SUDOL CROOK, MEGHAN CATHERINE (DPT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CATHERINE
Last Name:SUDOL CROOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2574
Mailing Address - Country:US
Mailing Address - Phone:914-682-6435
Mailing Address - Fax:914-681-3115
Practice Address - Street 1:194 JORALEMON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4312
Practice Address - Country:US
Practice Address - Phone:718-643-7116
Practice Address - Fax:718-643-7119
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist