Provider Demographics
NPI:1104024272
Name:ROUNDS, SUSAN M (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:ROUNDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 W 6TH
Mailing Address - Street 2:#206 SAGE & CEDAR PT
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2368
Mailing Address - Country:US
Mailing Address - Phone:208-882-4041
Mailing Address - Fax:
Practice Address - Street 1:317 W 6TH
Practice Address - Street 2:#206 SAGE & CEDAR PT
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2368
Practice Address - Country:US
Practice Address - Phone:208-882-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID PT 723225100000X
WAPT00003302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist