Provider Demographics
NPI:1073631602
Name:GILLESPIE, SUSANNE H (PT)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:H
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:H
Other - Last Name:STEBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:605 SIERRA ROSE DR STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2093
Practice Address - Country:US
Practice Address - Phone:775-689-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist