Provider Demographics
NPI:1790066397
Name:PETERS, SUSAN LURLEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LURLEEN
Last Name:PETERS
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 1:339 E JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-9206
Mailing Address - Country:US
Mailing Address - Phone:724-588-9613
Mailing Address - Fax:
Practice Address - Street 1:339 E JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-9206
Practice Address - Country:US
Practice Address - Phone:724-588-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005696L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist