Provider Demographics
NPI:1548206972
Name:MCGUIRE, SUSANNE STEPHENS (MPT, ATC, CHT)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:STEPHENS
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MPT, ATC, CHT
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4106 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4169
Practice Address - Country:US
Practice Address - Phone:302-894-1600
Practice Address - Fax:302-894-1601
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001056225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
485418OtherPABS
0199366000OtherAMERIHEALTH IBC
DE1000038247Medicaid
PA485418OtherPA BS PROVIDER NUMBER
PA0199366000OtherAMERIHEALTH PROVIDER ID
DE007174F68Medicare ID - Type Unspecified
DEG02378A03Medicare PIN
0199366000OtherAMERIHEALTH IBC
P00418678Medicare PIN