Provider Demographics
NPI:1467417568
Name:PUNDT, SUSAN MICHELE (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MICHELE
Last Name:PUNDT
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 1:4880 W. NEWBERRY RD. SUITE 180
Mailing Address - Street 2:BALANCED BODY PILATES
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-336-2266
Mailing Address - Fax:352-336-2475
Practice Address - Street 1:4880 N. NEWBERRY RD. SUITE 180
Practice Address - Street 2:BALANCED BODY PILATES
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-336-2266
Practice Address - Fax:352-336-2475
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10882208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4760OtherBLUE CROSS BLUE SHIELD
FLY4760OtherBLUE CROSS BLUE SHIELD