Provider Demographics
NPI:1790272078
Name:GALL, SUSAN G (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:GALL
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 1:75405 MACKEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-3528
Mailing Address - Country:US
Mailing Address - Phone:586-727-2120
Mailing Address - Fax:
Practice Address - Street 1:67267 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1919
Practice Address - Country:US
Practice Address - Phone:586-727-4530
Practice Address - Fax:586-727-9845
Is Sole Proprietor?:No
Enumeration Date:2018-04-22
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010061752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic