Provider Demographics
NPI:1013188911
Name:MURRAY, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5062
Mailing Address - Country:US
Mailing Address - Phone:904-276-0938
Mailing Address - Fax:904-276-4785
Practice Address - Street 1:839 WESTMINSTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5062
Practice Address - Country:US
Practice Address - Phone:904-276-0938
Practice Address - Fax:904-276-4785
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 1741225100000X
GAPT000736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist