Provider Demographics
NPI:1730132630
Name:PALACIO, SUSAN D (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
Last Name:PALACIO
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 1:15321 SW 74TH PL
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2488
Mailing Address - Country:US
Mailing Address - Phone:305-256-0204
Mailing Address - Fax:
Practice Address - Street 1:11025 SW 84TH ST
Practice Address - Street 2:COTTAGE #7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3804
Practice Address - Country:US
Practice Address - Phone:305-279-4141
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist