Provider Demographics
NPI:1780854182
Name:WATKINS, SUSAN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:WATKINS
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 1:205 SUGAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GILBOA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9104
Mailing Address - Country:US
Mailing Address - Phone:419-456-3338
Mailing Address - Fax:414-908-7212
Practice Address - Street 1:1725 WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1345
Practice Address - Country:US
Practice Address - Phone:419-422-5526
Practice Address - Fax:419-422-5526
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-5077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9313985Medicare PIN
OH4266941Medicare UPIN