Provider Demographics
NPI:1437241452
Name:DAVIDSON, SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DAVIDSON
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 1:2304 LARCHMONT PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5925
Mailing Address - Country:US
Mailing Address - Phone:919-621-2960
Mailing Address - Fax:
Practice Address - Street 1:3458 NEELY ROAD
Practice Address - Street 2:305 MDOS/SGOMY
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641-5321
Practice Address - Country:US
Practice Address - Phone:609-754-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist