Provider Demographics
NPI:1174665814
Name:MULCAHY, SUSAN A (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:COSTANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1155 35TH LN STE 100
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6522
Mailing Address - Country:US
Mailing Address - Phone:772-569-2330
Mailing Address - Fax:772-778-4809
Practice Address - Street 1:13230 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3748
Practice Address - Country:US
Practice Address - Phone:772-388-3911
Practice Address - Fax:772-388-1659
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL2961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9666YMedicare PIN