Provider Demographics
NPI:1689366619
Name:ROBERTS, SUSAN (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 16TH STREET RD STE 22
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5247
Mailing Address - Country:US
Mailing Address - Phone:304-523-2426
Mailing Address - Fax:
Practice Address - Street 1:3135 16TH STREET RD STE 22
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5247
Practice Address - Country:US
Practice Address - Phone:304-523-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant