Provider Demographics
NPI:1215368220
Name:SUSA, VICTORIA J (DPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:J
Last Name:SUSA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-0820
Mailing Address - Country:US
Mailing Address - Phone:406-778-3331
Mailing Address - Fax:406-778-5163
Practice Address - Street 1:202 S 4TH ST W
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313-9156
Practice Address - Country:US
Practice Address - Phone:406-778-3331
Practice Address - Fax:406-778-5163
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPT PPT LIC 6014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist