Provider Demographics
NPI:1124378419
Name:KESTNER, SUSAN (CPO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KESTNER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 ANDERSON SQ
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8401
Mailing Address - Country:US
Mailing Address - Phone:512-377-2323
Mailing Address - Fax:512-374-9993
Practice Address - Street 1:8000 ANDERSON SQ
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8401
Practice Address - Country:US
Practice Address - Phone:512-377-2323
Practice Address - Fax:512-374-9993
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1363222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist