Provider Demographics
NPI:1376777565
Name:SUSMENA, PIODEL BALGOS (PT)
Entity Type:Individual
Prefix:MR
First Name:PIODEL
Middle Name:BALGOS
Last Name:SUSMENA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-2552
Mailing Address - Country:US
Mailing Address - Phone:618-548-8633
Mailing Address - Fax:618-548-8633
Practice Address - Street 1:501 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2552
Practice Address - Country:US
Practice Address - Phone:618-548-8633
Practice Address - Fax:618-548-8633
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist