Provider Demographics
NPI:1083744189
Name:BROWN, SUSAN LORRAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LORRAINE
Last Name:BROWN
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 1:5 CALLE ALBARDA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2309
Mailing Address - Country:US
Mailing Address - Phone:949-858-0330
Mailing Address - Fax:949-858-0330
Practice Address - Street 1:5 CALLE ALBARDA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2309
Practice Address - Country:US
Practice Address - Phone:949-858-0330
Practice Address - Fax:949-858-0330
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist