Provider Demographics
NPI:1346235900
Name:PRATT, SUSAN (MPT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25512 RUE TERRASE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4310
Mailing Address - Country:US
Mailing Address - Phone:949-388-4243
Mailing Address - Fax:
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:# 13B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-830-6220
Practice Address - Fax:949-830-6227
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25877261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20444Medicare PIN