Provider Demographics
NPI:1790903284
Name:CHARLWOOD, SUSAN THERESE (PT, MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:THERESE
Last Name:CHARLWOOD
Suffix:
Gender:F
Credentials:PT, MSW
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:THERESE
Other - Last Name:BALKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:58 E KILLINGLY RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1428
Mailing Address - Country:US
Mailing Address - Phone:401-647-2975
Mailing Address - Fax:
Practice Address - Street 1:34 DANIELSON PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1802
Practice Address - Country:US
Practice Address - Phone:401-647-4455
Practice Address - Fax:401-647-4456
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00157225100000X
MA1602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist