Provider Demographics
NPI:1477731347
Name:LONG, SUE A (PTA)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 KEEWAYDIN DRIVE
Mailing Address - Street 2:CORE MEDICAL GROUP
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:413-717-4025
Mailing Address - Fax:
Practice Address - Street 1:2 KEEWAYDIN DRIVE
Practice Address - Street 2:CORE MEDICAL GROUP
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:800-995-2673
Practice Address - Fax:888-979-6551
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2873225200000X
NJ40QB00304300225200000X
CT000815225200000X
PATE009711225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant