Provider Demographics
NPI:1417019779
Name:THIEL, SUSAN FRANCES (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FRANCES
Last Name:THIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:FRANCES
Other - Last Name:SEDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1405 N HUNT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2656
Mailing Address - Country:US
Mailing Address - Phone:847-855-2890
Mailing Address - Fax:847-855-2147
Practice Address - Street 1:1405 N HUNT CLUB RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2656
Practice Address - Country:US
Practice Address - Phone:847-855-2890
Practice Address - Fax:847-855-2147
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4464225100000X
IL070006125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist