Provider Demographics
NPI:1275661548
Name:DUTTWEILER, SUSAN (PT, CEAS, CFCE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:DUTTWEILER
Suffix:
Gender:F
Credentials:PT, CEAS, CFCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28035 AVENUE SANFORD WEST
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:219-545-9057
Mailing Address - Fax:
Practice Address - Street 1:1105 53RD AVE E STE A
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4897
Practice Address - Country:US
Practice Address - Phone:941-755-2562
Practice Address - Fax:941-758-4065
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28189225100000X
IN05001508A225100000X
IL070004271225100000X
GA010833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist