Provider Demographics
NPI:1477761690
Name:RAMIREZ, SUSANNE MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARIE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 PORT ORANGE WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-2915
Mailing Address - Country:US
Mailing Address - Phone:239-289-8297
Mailing Address - Fax:239-596-8901
Practice Address - Street 1:900 IMPERIAL GOLF COURSE BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1085
Practice Address - Country:US
Practice Address - Phone:239-591-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17465225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant