Provider Demographics
NPI:1679652572
Name:MCGANN, SUSAN B (PT,OCS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:MCGANN
Suffix:
Gender:F
Credentials:PT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OWENS BEACH ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:HARBINGER
Mailing Address - State:NC
Mailing Address - Zip Code:27941-9758
Mailing Address - Country:US
Mailing Address - Phone:252-457-1090
Mailing Address - Fax:252-457-1091
Practice Address - Street 1:6385 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:GRANDY
Practice Address - State:NC
Practice Address - Zip Code:27939-9617
Practice Address - Country:US
Practice Address - Phone:252-457-1090
Practice Address - Fax:252-457-1091
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211765Medicaid
NC2506652Medicare ID - Type Unspecified