Provider Demographics
NPI:1922625110
Name:MANDEL, SUSAN MORGAN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MORGAN
Last Name:MANDEL
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 1:40 GIORGETTI BLVD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3712
Mailing Address - Country:US
Mailing Address - Phone:802-775-9959
Mailing Address - Fax:
Practice Address - Street 1:279 BUSINESS ROUTE 4 STE 1
Practice Address - Street 2:
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9701
Practice Address - Country:US
Practice Address - Phone:802-775-4372
Practice Address - Fax:802-775-4918
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0002592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist