Provider Demographics
NPI:1326555228
Name:WEBB, SUSAN CHRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:WEBB
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CHRISTINE
Other - Last Name:BUJAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3919 GLORIA ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1956
Mailing Address - Country:US
Mailing Address - Phone:734-788-9362
Mailing Address - Fax:
Practice Address - Street 1:3919 GLORIA ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1956
Practice Address - Country:US
Practice Address - Phone:734-788-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010011652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer