Provider Demographics
NPI:1730692534
Name:CHADWICK, EMILY RUTH (ATC)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:RUTH
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TERRACE CIR APT 1C
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4187
Mailing Address - Country:US
Mailing Address - Phone:603-491-8065
Mailing Address - Fax:
Practice Address - Street 1:30 TERRACE CIR APT 1C
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4187
Practice Address - Country:US
Practice Address - Phone:603-491-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty