Provider Demographics
NPI:1225115611
Name:DIMARTINI, SUSAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:DIMARTINI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25921 POPE PL
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1148
Mailing Address - Country:US
Mailing Address - Phone:818-333-1690
Mailing Address - Fax:818-333-1697
Practice Address - Street 1:4111 W ALAMEDA AVE
Practice Address - Street 2:STE 110
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4161
Practice Address - Country:US
Practice Address - Phone:818-333-1690
Practice Address - Fax:818-333-1697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT21725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT21725AMedicare ID - Type Unspecified