Provider Demographics
NPI:1760727747
Name:RICE, SUSAN (RPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SCHULTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 MIX AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2102
Mailing Address - Country:US
Mailing Address - Phone:203-281-3500
Mailing Address - Fax:
Practice Address - Street 1:850 MIX AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2102
Practice Address - Country:US
Practice Address - Phone:203-281-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0003441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist