Provider Demographics
NPI:1568787935
Name:GUENARD, SUSAN M (MS, PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GUENARD
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CONVERSE ST.
Mailing Address - Street 2:JEWISH NURSING HOME
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1786
Mailing Address - Country:US
Mailing Address - Phone:413-567-6211
Mailing Address - Fax:413-567-2477
Practice Address - Street 1:770 CONVERSE ST
Practice Address - Street 2:JEWISH NURSING HOME
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1719
Practice Address - Country:US
Practice Address - Phone:413-567-6211
Practice Address - Fax:413-567-2477
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist