Provider Demographics
NPI:1477504983
Name:STATON, SUSAN BULLARD (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BULLARD
Last Name:STATON
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 1:728 ACCREE EDMUNDSON RD
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874-8564
Mailing Address - Country:US
Mailing Address - Phone:252-826-2099
Mailing Address - Fax:
Practice Address - Street 1:728 ACCREE EDMUNDSON RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-8564
Practice Address - Country:US
Practice Address - Phone:252-826-2099
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics