Provider Demographics
NPI:1730819202
Name:HAKE, SUZANNE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:HAKE
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 1:2A RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1408
Mailing Address - Country:US
Mailing Address - Phone:585-343-5384
Mailing Address - Fax:
Practice Address - Street 1:2A RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1408
Practice Address - Country:US
Practice Address - Phone:585-343-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010165-012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010165-01OtherNEW YORK STATE EDUCATION DEPARTMENT