Provider Demographics
NPI:1679552087
Name:ANDREWS, SUSAN MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:PA
Mailing Address - Zip Code:17752-1120
Mailing Address - Country:US
Mailing Address - Phone:570-547-0480
Mailing Address - Fax:570-547-0498
Practice Address - Street 1:43 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:PA
Practice Address - Zip Code:17752-1120
Practice Address - Country:US
Practice Address - Phone:570-547-0480
Practice Address - Fax:570-547-0498
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011315740001Medicaid
PA099882Medicare UPIN