Provider Demographics
NPI:1801029541
Name:SMITH, SUSAN NOELLE (DPT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NOELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N COURT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-5551
Mailing Address - Country:US
Mailing Address - Phone:662-455-1313
Mailing Address - Fax:662-459-7139
Practice Address - Street 1:810 N COURT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5551
Practice Address - Country:US
Practice Address - Phone:662-455-1313
Practice Address - Fax:662-459-7139
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist