Provider Demographics
NPI:1467540260
Name:KING, SUSAN M (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:KING
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 1:390 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5534
Mailing Address - Country:US
Mailing Address - Phone:201-599-3923
Mailing Address - Fax:
Practice Address - Street 1:275 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5426
Practice Address - Country:US
Practice Address - Phone:201-634-6900
Practice Address - Fax:201-634-6905
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00416400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist