Provider Demographics
NPI:1033169503
Name:HABERKORN, SUSAN B (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:HABERKORN
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 1:311 N DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5132
Mailing Address - Country:US
Mailing Address - Phone:229-226-4114
Mailing Address - Fax:229-226-6408
Practice Address - Street 1:311 N DAWSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5132
Practice Address - Country:US
Practice Address - Phone:229-226-4114
Practice Address - Fax:229-226-6408
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist