Provider Demographics
NPI:1114258316
Name:SOROOSH, SUSANNA (PT)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:SOROOSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:HIRST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:235 HOBBS ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-6943
Mailing Address - Country:US
Mailing Address - Phone:405-408-9269
Mailing Address - Fax:
Practice Address - Street 1:235 HOBBS ST UNIT A
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-6943
Practice Address - Country:US
Practice Address - Phone:405-408-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist