Provider Demographics
NPI:1164912515
Name:PETHEL, SUSAN (MPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PETHEL
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 1:10 WHITLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-6302
Mailing Address - Country:US
Mailing Address - Phone:828-713-4556
Mailing Address - Fax:
Practice Address - Street 1:SOUTHEASTERN PHYSICAL THERAPY, LLC.
Practice Address - Street 2:23 TURTLE CREEK DRIVE
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-274-2188
Practice Address - Fax:828-274-7843
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP7520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist