Provider Demographics
NPI:1093869893
Name:HORWATH, SUSAN M (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HORWATH
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:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-0846
Mailing Address - Country:US
Mailing Address - Phone:321-363-7620
Mailing Address - Fax:
Practice Address - Street 1:1706 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136
Practice Address - Country:US
Practice Address - Phone:321-363-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLPT0005975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880655100Medicaid
FLY4972OtherBC BS PROVIDER #