Provider Demographics
NPI:1578601175
Name:JAVIDAN, SUSAN J (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:JAVIDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9750 MIRAMAR RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4561
Mailing Address - Country:US
Mailing Address - Phone:858-693-3196
Mailing Address - Fax:858-693-3879
Practice Address - Street 1:9750 MIRAMAR RD STE 160
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4561
Practice Address - Country:US
Practice Address - Phone:858-693-3196
Practice Address - Fax:858-693-3879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist