Provider Demographics
NPI:1760551089
Name:BLUE, SUSAN DIANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DIANE
Last Name:BLUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:275 CENTURY CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9453
Mailing Address - Country:US
Mailing Address - Phone:303-926-1444
Mailing Address - Fax:303-926-0038
Practice Address - Street 1:275 CENTURY CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9729
Practice Address - Country:US
Practice Address - Phone:303-926-1444
Practice Address - Fax:303-926-0038
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist