Provider Demographics
NPI:1083878375
Name:GRAVES, SUSAN KAY (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:16991 TEXAS SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4310
Mailing Address - Country:US
Mailing Address - Phone:530-243-0446
Mailing Address - Fax:530-242-8349
Practice Address - Street 1:2120 BENTON DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2151
Practice Address - Country:US
Practice Address - Phone:530-243-2220
Practice Address - Fax:530-242-8349
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1259225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant