Provider Demographics
NPI:1033426838
Name:PIERCE, SUSAN MCGHEE (MPT, CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MCGHEE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MPT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 GERMANTOWN AVE
Mailing Address - Street 2:SUITE 35
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2722
Mailing Address - Country:US
Mailing Address - Phone:215-248-8030
Mailing Address - Fax:215-248-8326
Practice Address - Street 1:8815 GERMANTOWN AVE
Practice Address - Street 2:SUITE 35
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-248-8030
Practice Address - Fax:215-248-8326
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008493L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102525260Medicaid
PA102525260Medicaid