Provider Demographics
NPI:1528181021
Name:ROVNAK, SUSAN ELIZABETH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:ROVNAK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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 50105
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-4105
Mailing Address - Country:US
Mailing Address - Phone:410-889-8004
Mailing Address - Fax:410-889-8024
Practice Address - Street 1:3612 FALLS RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1814
Practice Address - Country:US
Practice Address - Phone:410-889-8004
Practice Address - Fax:410-889-8024
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16168225100000X
FLPT16231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD637M138FMedicare ID - Type Unspecified
MDP20586Medicare UPIN