Provider Demographics
NPI:1225276181
Name:DORRIS, SUSAN PAULETTE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:PAULETTE
Last Name:DORRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 S ALASKA ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1317
Mailing Address - Country:US
Mailing Address - Phone:253-476-5300
Mailing Address - Fax:253-476-5365
Practice Address - Street 1:6220 S ALASKA ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1317
Practice Address - Country:US
Practice Address - Phone:253-476-5300
Practice Address - Fax:253-476-5365
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60039275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant