Provider Demographics
NPI:1760494173
Name:DANIEL, SUSAN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:DANIEL
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 1:3425 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1326
Mailing Address - Country:US
Mailing Address - Phone:419-537-0764
Mailing Address - Fax:419-537-0948
Practice Address - Street 1:5450 MONROE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2879
Practice Address - Country:US
Practice Address - Phone:419-841-1096
Practice Address - Fax:419-841-3876
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT004986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist