Provider Demographics
NPI:1568529238
Name:LANG, SUSAN FERRIER
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FERRIER
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:FERRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-0172
Mailing Address - Country:US
Mailing Address - Phone:860-434-1190
Mailing Address - Fax:860-434-1190
Practice Address - Street 1:19 HALLS RD
Practice Address - Street 2:SUITE 213
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1457
Practice Address - Country:US
Practice Address - Phone:860-434-1190
Practice Address - Fax:860-434-1190
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080005063CT05OtherBLUE CROSS & BLUE SHIELD