Provider Demographics
NPI:1780841098
Name:TEFFT, SUSAN C (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:TEFFT
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 1:186 TURQUOISE LN
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-8848
Mailing Address - Country:US
Mailing Address - Phone:941-966-4512
Mailing Address - Fax:
Practice Address - Street 1:2415 UNIVERSITY PKWY
Practice Address - Street 2:BUILDING 3 SUITE 216
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2809
Practice Address - Country:US
Practice Address - Phone:941-359-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000050600Medicaid
FL000472400Medicaid