Provider Demographics
NPI:1043243934
Name:MANN, SUSAN L (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:MANN
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 1:7400 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2306
Mailing Address - Country:US
Mailing Address - Phone:520-531-0305
Mailing Address - Fax:520-742-4907
Practice Address - Street 1:7400 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2306
Practice Address - Country:US
Practice Address - Phone:520-531-0305
Practice Address - Fax:520-742-4907
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103000Medicare PIN
AZZ120473Medicare PIN
AZZ118872Medicare PIN