Provider Demographics
NPI:1144791419
Name:CECERE, SUSAN WOOD X (PT, MHS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WOOD
Last Name:CECERE
Suffix:X
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KELLY CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2458
Mailing Address - Country:US
Mailing Address - Phone:443-995-3546
Mailing Address - Fax:
Practice Address - Street 1:2 KELLY CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2458
Practice Address - Country:US
Practice Address - Phone:443-995-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist