Provider Demographics
NPI:1457643736
Name:FAIN, SUSAN DAWN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DAWN
Last Name:FAIN
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 1:800 W ARBROOK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4327
Mailing Address - Country:US
Mailing Address - Phone:817-472-2200
Mailing Address - Fax:817-467-9021
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:817-472-2200
Practice Address - Fax:817-467-9021
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist