Provider Demographics
NPI:1588040430
Name:BURGESS, SUSAN JILL (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JILL
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JILL
Other - Last Name:HUXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1597 WASHINGTON PIKE STE A15
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2874
Mailing Address - Country:US
Mailing Address - Phone:412-278-1221
Mailing Address - Fax:
Practice Address - Street 1:1597 WASHINGTON PIKE STE A15
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2874
Practice Address - Country:US
Practice Address - Phone:412-278-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003529225100000X
PAPT029582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810029542Medicaid
WV3810029542Medicaid