Provider Demographics
NPI:1821528977
Name:PODOLIN, SUSAN HARRISON (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HARRISON
Last Name:PODOLIN
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 1:1390 BROADNECK CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5484
Mailing Address - Country:US
Mailing Address - Phone:410-353-8654
Mailing Address - Fax:
Practice Address - Street 1:2001 TIDEWATER COLONY DR STE 102
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2592
Practice Address - Country:US
Practice Address - Phone:410-266-8010
Practice Address - Fax:443-782-2498
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist