Provider Demographics
NPI:1609944891
Name:MCINTOSH, SUSANNE ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:ELIZABETH
Last Name:MCINTOSH
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 1:3603 SE 9TH PL
Mailing Address - Street 2:#6
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:239-699-8795
Mailing Address - Fax:
Practice Address - Street 1:1413 VISCAYA PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6206
Practice Address - Country:US
Practice Address - Phone:239-242-9970
Practice Address - Fax:239-242-0076
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4844XMedicare PIN