Provider Demographics
NPI:1619171584
Name:MALONE, SUSAN A (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:MALONE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3317
Mailing Address - Country:US
Mailing Address - Phone:203-417-9433
Mailing Address - Fax:860-350-0285
Practice Address - Street 1:22 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3317
Practice Address - Country:US
Practice Address - Phone:203-417-9433
Practice Address - Fax:860-350-0285
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004046OtherPHYSICAL THERAPY