Provider Demographics
NPI:1710999701
Name:ABIS, SUSAN C (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:ABIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 MIDDLESEX ROAD
Mailing Address - Street 2:6
Mailing Address - City:TYNGSBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1028
Mailing Address - Country:US
Mailing Address - Phone:978-649-2592
Mailing Address - Fax:978-649-4620
Practice Address - Street 1:315 MIDDLESEX ROAD
Practice Address - Street 2:6
Practice Address - City:TYNGSBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01879-1028
Practice Address - Country:US
Practice Address - Phone:978-649-2592
Practice Address - Fax:978-649-4620
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0377473Medicaid
MA607967OtherTUFTS
MAY65368OtherBCBS
MA0377473Medicaid