Provider Demographics
NPI:1346314846
Name:EARLES, SUSAN NADINE (PT MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NADINE
Last Name:EARLES
Suffix:
Gender:F
Credentials:PT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 WEST RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-223-1983
Mailing Address - Fax:276-223-1316
Practice Address - Street 1:1995 WEST RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-223-1983
Practice Address - Fax:276-223-1316
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008954895Medicaid
P00038606OtherRAILROAD MEDICARE
2116103OtherMAMSI UHC
193870OtherANTHEM
P00038606OtherRAILROAD MEDICARE
2116103OtherMAMSI UHC