Provider Demographics
NPI:1164826376
Name:GREENBLATT, SUSANNE (PT)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:GREENBLATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BLOSSOM RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3195
Mailing Address - Country:US
Mailing Address - Phone:770-964-7380
Mailing Address - Fax:
Practice Address - Street 1:140 BLOSSOM RIDGE TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3195
Practice Address - Country:US
Practice Address - Phone:770-964-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist