Provider Demographics
NPI:1477529196
Name:BAUTISTA, SUSAN R (RPT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:RPT
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Mailing Address - Street 1:2089 CECIL ASHBURN DR SE
Mailing Address - Street 2:STE 202
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2569
Mailing Address - Country:US
Mailing Address - Phone:256-270-9922
Mailing Address - Fax:256-270-9923
Practice Address - Street 1:6767 OLD MADISON PIKE
Practice Address - Street 2:SUITE 400 HGA HOME HEALTH
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-922-6650
Practice Address - Fax:256-922-6651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2021-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH3746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519592OtherBLUE CROSS BLUE SHIELD