Provider Demographics
NPI:1467006288
Name:GREENFIELD, SUSAN RACHEL (PTA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RACHEL
Last Name:GREENFIELD
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 1:515 PLYMOUTH RD APT N1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1633
Mailing Address - Country:US
Mailing Address - Phone:215-266-8516
Mailing Address - Fax:
Practice Address - Street 1:515 PLYMOUTH RD APT N1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1633
Practice Address - Country:US
Practice Address - Phone:215-266-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003576225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant