Provider Demographics
NPI:1760798110
Name:JANE, SUSANNAH JO (DPT)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:JO
Last Name:JANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:SUSANNAH
Other - Middle Name:JO
Other - Last Name:BIERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 W RIDGELY RD
Practice Address - Street 2:SUITE A
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5135
Practice Address - Country:US
Practice Address - Phone:443-921-9890
Practice Address - Fax:410-252-4590
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist