Provider Demographics
NPI:1750502506
Name:DUGUID, SUSAN LYNN (PT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:LYNN
Last Name:DUGUID
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 350592
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80035-0592
Mailing Address - Country:US
Mailing Address - Phone:303-345-4515
Mailing Address - Fax:
Practice Address - Street 1:11450 MELODY DR
Practice Address - Street 2:C-101
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3099
Practice Address - Country:US
Practice Address - Phone:303-345-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85162251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53275233Medicaid