Provider Demographics
NPI:1467533265
Name:VANSTON, SUSAN WATTLEWORTH (MS PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WATTLEWORTH
Last Name:VANSTON
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 BELMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 BELMONT BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5105
Practice Address - Country:US
Practice Address - Phone:615-297-8419
Practice Address - Fax:615-297-8419
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist