Provider Demographics
NPI:1922178839
Name:PETERSON, SUSAN F (RRT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:F
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BROADREACH
Mailing Address - Street 2:T114-B
Mailing Address - City:NORTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61 BROAD REACH
Practice Address - Street 2:T114-B
Practice Address - City:NORTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191-2229
Practice Address - Country:US
Practice Address - Phone:617-732-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4054227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered