Provider Demographics
NPI:1689749699
Name:KELVASA, SUSAN (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:KELVASA
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 1:2501 KUSER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3386
Mailing Address - Country:US
Mailing Address - Phone:609-896-0444
Mailing Address - Fax:609-896-1126
Practice Address - Street 1:2501 KUSER RD STE 3
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:609-896-0444
Practice Address - Fax:609-896-1126
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00292900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042515Medicare PIN
PA266029Medicare PIN