Provider Demographics
NPI:1487003794
Name:GOLIASZEWSKI, SUSAN (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GOLIASZEWSKI
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 1:607 ORIOLE PL
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-2055
Mailing Address - Country:US
Mailing Address - Phone:302-235-8423
Mailing Address - Fax:
Practice Address - Street 1:607 ORIOLE PL
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2055
Practice Address - Country:US
Practice Address - Phone:302-235-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000687225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant