Provider Demographics
NPI:1376769703
Name:SABLON, SUSAN M (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SABLON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10703 HEATHER GREENS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SPOTYSLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553
Mailing Address - Country:US
Mailing Address - Phone:540-735-0260
Mailing Address - Fax:540-735-0262
Practice Address - Street 1:195 FALCON DR.
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22553
Practice Address - Country:US
Practice Address - Phone:540-735-0260
Practice Address - Fax:540-735-0262
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant