Provider Demographics
NPI:1275132250
Name:OZOG, SUSAN JOSEPHINE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOSEPHINE
Last Name:OZOG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HILLDALE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1633
Mailing Address - Country:US
Mailing Address - Phone:619-757-4702
Mailing Address - Fax:
Practice Address - Street 1:904C BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3303
Practice Address - Country:US
Practice Address - Phone:508-845-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic