Provider Demographics
NPI:1255495669
Name:HOPE, SUSAN S (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:HOPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:S
Other - Last Name:CTIBOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233
Mailing Address - Country:US
Mailing Address - Phone:404-405-3451
Mailing Address - Fax:770-412-8576
Practice Address - Street 1:2395 HWY 36 E
Practice Address - Street 2:
Practice Address - City:MILNER
Practice Address - State:GA
Practice Address - Zip Code:30257
Practice Address - Country:US
Practice Address - Phone:404-405-3451
Practice Address - Fax:770-412-8576
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40742251P0200X
GAPT0040742251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000747073BMedicaid