Provider Demographics
NPI:1801185327
Name:IRWIN, SUSAN ANN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:IRWIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:IRWIN
Other - Last Name:MARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:618 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-3111
Mailing Address - Country:US
Mailing Address - Phone:830-583-9948
Mailing Address - Fax:830-393-8828
Practice Address - Street 1:2004 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-2770
Practice Address - Country:US
Practice Address - Phone:830-393-8800
Practice Address - Fax:830-393-8828
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist