Provider Demographics
NPI:1851507834
Name:CRONE-JACKSON, SUSANNE MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MARIE
Last Name:CRONE-JACKSON
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 1:2821 NE 3RD ST
Mailing Address - Street 2:APT-3
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7070
Mailing Address - Country:US
Mailing Address - Phone:352-787-9300
Mailing Address - Fax:
Practice Address - Street 1:600 W NORTH BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-787-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA9044225200000X
PATE000972L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant