Provider Demographics
NPI:1417159815
Name:OVERMAN, SUSAN MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:OVERMAN
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 1:722 W MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-2119
Mailing Address - Country:US
Mailing Address - Phone:602-953-9173
Mailing Address - Fax:602-953-9173
Practice Address - Street 1:2400 W DUNLAP AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2817
Practice Address - Country:US
Practice Address - Phone:602-870-1414
Practice Address - Fax:602-870-4141
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant