Provider Demographics
NPI:1558580415
Name:NORTHEY, SUSAN
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:NORTHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:NORTHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:720 DEVON HILL COURT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5584
Mailing Address - Country:US
Mailing Address - Phone:770-664-4865
Mailing Address - Fax:
Practice Address - Street 1:720 DEVON HILL COURT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5584
Practice Address - Country:US
Practice Address - Phone:770-664-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist