Provider Demographics
NPI:1174868236
Name:LEGERE, SUSAN ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNE
Last Name:LEGERE
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 1:3 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1717
Mailing Address - Country:US
Mailing Address - Phone:978-750-4243
Mailing Address - Fax:
Practice Address - Street 1:63 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2240
Practice Address - Country:US
Practice Address - Phone:978-777-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3934OtherCOMMONWEALTH OF MASSACHUSETTS