Provider Demographics
NPI:1083866495
Name:RABOURN, SUSAN B (P T)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:RABOURN
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922-2300
Mailing Address - Country:US
Mailing Address - Phone:831-659-1946
Mailing Address - Fax:
Practice Address - Street 1:245 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8650
Practice Address - Country:US
Practice Address - Phone:831-620-0744
Practice Address - Fax:831-620-0711
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34988225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 34988OtherPHYSICAL THERAPIST LICENSE
NC1062OtherPHYSICAL THERAPIST LICENSE