Provider Demographics
NPI:1811362478
Name:HAMBY, SUSAN (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HAMBY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:FRANKTON
Mailing Address - State:IN
Mailing Address - Zip Code:46044-0113
Mailing Address - Country:US
Mailing Address - Phone:765-425-9322
Mailing Address - Fax:
Practice Address - Street 1:808 EAST SIGLER STREET
Practice Address - Street 2:
Practice Address - City:FRANKTON
Practice Address - State:IN
Practice Address - Zip Code:46044-0113
Practice Address - Country:US
Practice Address - Phone:765-425-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004680A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant