Provider Demographics
NPI:1598797615
Name:WHITE, SUSAN M (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 STATE ROUTE 94
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07832-2764
Mailing Address - Country:US
Mailing Address - Phone:908-362-6172
Mailing Address - Fax:908-362-6406
Practice Address - Street 1:210 STATE ROUTE 94
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2764
Practice Address - Country:US
Practice Address - Phone:908-362-6172
Practice Address - Fax:908-362-6406
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA04871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058396SUSMedicare ID - Type Unspecified