Provider Demographics
NPI:1891930129
Name:EBLE, SUSAN LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:EBLE
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 1:9633 154TH RD N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:561-741-2897
Practice Address - Street 1:9633 154TH RD N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6988
Practice Address - Country:US
Practice Address - Phone:561-252-8862
Practice Address - Fax:561-741-2897
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT045392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic