Provider Demographics
NPI:1164725347
Name:SOMERNDIKE, SUSAN IRENE (MPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:IRENE
Last Name:SOMERNDIKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 N KLAMATH PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3252
Mailing Address - Country:US
Mailing Address - Phone:714-974-5911
Mailing Address - Fax:714-912-4729
Practice Address - Street 1:1660 N KLAMATH PL
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3252
Practice Address - Country:US
Practice Address - Phone:714-974-5911
Practice Address - Fax:714-912-4729
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist