Provider Demographics
NPI:1295821064
Name:LIMBURG, SUSAN W (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:LIMBURG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 STONE EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-2317
Mailing Address - Country:US
Mailing Address - Phone:410-823-1918
Mailing Address - Fax:410-823-0738
Practice Address - Street 1:12838 STONE EAGLE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-2317
Practice Address - Country:US
Practice Address - Phone:410-823-1918
Practice Address - Fax:410-823-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
620RMedicare ID - Type Unspecified