Provider Demographics
NPI:1679740732
Name:GARRETTSON, SUSAN E (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:GARRETTSON
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:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0324
Mailing Address - Country:US
Mailing Address - Phone:207-564-0406
Mailing Address - Fax:207-564-0405
Practice Address - Street 1:64 E MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1398
Practice Address - Country:US
Practice Address - Phone:207-564-0406
Practice Address - Fax:207-564-0405
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME308590099Medicaid