Provider Demographics
NPI:1386846780
Name:FLEMMING, SUSAN L (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:FLEMMING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 FOREST DR A
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4430
Mailing Address - Country:US
Mailing Address - Phone:443-415-8917
Mailing Address - Fax:410-268-9401
Practice Address - Street 1:1831 FOREST DR A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4430
Practice Address - Country:US
Practice Address - Phone:443-415-8917
Practice Address - Fax:410-268-9401
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1679630073OtherFACILITY NPI NUMBER
MD283MR005OtherPTAN, MEDICARE