Provider Demographics
NPI:1043483563
Name:LETOURNEAU, SUSAN (RRT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:LETOURNEAU
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEBB SAUNDERS RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-6703
Mailing Address - Country:US
Mailing Address - Phone:828-452-8060
Mailing Address - Fax:828-452-8063
Practice Address - Street 1:75 LEROY GEORGE DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7461
Practice Address - Country:US
Practice Address - Phone:828-452-8060
Practice Address - Fax:828-452-8060
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-38522279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34-0025Medicare PIN