Provider Demographics
NPI:1518038397
Name:HANCOCK, SUSAN D (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:D
Other - Last Name:SLONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2800 BOLD RULER DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-9596
Mailing Address - Country:US
Mailing Address - Phone:502-541-8054
Mailing Address - Fax:502-228-5698
Practice Address - Street 1:2800 BOLD RULER DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026-9596
Practice Address - Country:US
Practice Address - Phone:502-541-8054
Practice Address - Fax:502-228-5698
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist