Provider Demographics
NPI:1003063645
Name:DUBROFF, SUSAN KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:DUBROFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:DOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1708 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4545
Mailing Address - Country:US
Mailing Address - Phone:410-578-5224
Mailing Address - Fax:
Practice Address - Street 1:1708 W ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4545
Practice Address - Country:US
Practice Address - Phone:410-578-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163122251P0200X
CA121522251P0200X
MI55010012312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD463100500Medicaid