Provider Demographics
NPI:1003074576
Name:FLYNN, SUSAN CAROLINE (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROLINE
Last Name:FLYNN
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 1:210 W MAGNOLIA ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2915
Mailing Address - Country:US
Mailing Address - Phone:970-221-1201
Mailing Address - Fax:800-675-0273
Practice Address - Street 1:210 W MAGNOLIA ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2915
Practice Address - Country:US
Practice Address - Phone:970-221-1201
Practice Address - Fax:800-675-0273
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82972251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics