Provider Demographics
NPI:1497039283
Name:SWETTER, SUSIE ALICE (DPT)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:ALICE
Last Name:SWETTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-1540
Mailing Address - Country:US
Mailing Address - Phone:570-309-9715
Mailing Address - Fax:
Practice Address - Street 1:3102 GRIMES AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2934
Practice Address - Country:US
Practice Address - Phone:570-309-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021472225100000X
IDPT-2961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist