Provider Demographics
NPI:1396815494
Name:FALTICO, SUSAN GEMMILL (MS, PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GEMMILL
Last Name:FALTICO
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 CAMINITO PESCADO UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1925
Mailing Address - Country:US
Mailing Address - Phone:619-795-1657
Mailing Address - Fax:
Practice Address - Street 1:2250 CAMINITO PESCADO UNIT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1925
Practice Address - Country:US
Practice Address - Phone:619-795-1657
Practice Address - Fax:619-795-1657
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26596AMedicare ID - Type Unspecified
CAQ61724Medicare UPIN