Provider Demographics
NPI:1477688562
Name:SANNELLA FLEMING, SUSAN RITA (PT,DPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RITA
Last Name:SANNELLA FLEMING
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 W HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3116
Mailing Address - Country:US
Mailing Address - Phone:781-438-8571
Mailing Address - Fax:
Practice Address - Street 1:151 EVERETT AVE
Practice Address - Street 2:MGH CHELSEA HEALTHCARE CENTER PHYSICAL THERAPY DEPT.
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1812
Practice Address - Country:US
Practice Address - Phone:617-887-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9116OtherMA LICENSURE NUMBER