Provider Demographics
NPI:1881722106
Name:SUTTER-REIZOVIC, SELENA (PT)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:
Last Name:SUTTER-REIZOVIC
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 1:59 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2505
Mailing Address - Country:US
Mailing Address - Phone:516-383-8279
Mailing Address - Fax:
Practice Address - Street 1:59 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2505
Practice Address - Country:US
Practice Address - Phone:516-383-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015597-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist