Provider Demographics
NPI:1508085952
Name:AUSTIN, SUE ERICSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ERICSON
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:ERICSON
Other - Last Name:BRANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:828-258-8800
Mailing Address - Fax:
Practice Address - Street 1:89 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4838
Practice Address - Country:US
Practice Address - Phone:828-258-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01748225100000X
NCP19920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39259OtherWELLMARK PROVIDER NUMBER
NCP19920OtherPT LICENSE