Provider Demographics
NPI:1306845383
Name:DUGO, SUSAN M (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DUGO
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 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:#205
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-584-5626
Mailing Address - Fax:623-584-8998
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:#205
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-584-5626
Practice Address - Fax:623-584-8998
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2Z4613OtherHEALTH NET
AZCN1748OtherRAILROAD MEDICARE
AZ895056OtherUNITED HEALTHCARE
AZP00298983OtherRAILROAD MEDICARE
AZ780454OtherAHCCCS
AZP0298960OtherBC/BS AZ
AZ29020Medicare PIN
AZCN1748OtherRAILROAD MEDICARE
AZ109270Medicare UPIN