Provider Demographics
NPI:1558518100
Name:CHUNG, SUSAN A (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:CHUNG
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 1:10324 N 62ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1231
Mailing Address - Country:US
Mailing Address - Phone:623-979-0066
Mailing Address - Fax:623-979-0052
Practice Address - Street 1:2122 E HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4739
Practice Address - Country:US
Practice Address - Phone:602-778-0900
Practice Address - Fax:602-778-6606
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8149OtherSTATE LICENSE NUMBER