Provider Demographics
NPI:1235568510
Name:MEYERSON, SUSAN E (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MEYERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:9455 LORTON MARKET ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1962
Mailing Address - Country:US
Mailing Address - Phone:703-971-3701
Mailing Address - Fax:
Practice Address - Street 1:9455 LORTON MARKET ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1962
Practice Address - Country:US
Practice Address - Phone:703-971-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23061007225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant