Provider Demographics
NPI:1932476306
Name:TAVES, SUSAN J (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:TAVES
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:PO BOX 1426
Mailing Address - Street 2:2554 BRAINERS ROAD
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-1426
Mailing Address - Country:US
Mailing Address - Phone:360-730-1440
Mailing Address - Fax:
Practice Address - Street 1:311 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3427
Practice Address - Country:US
Practice Address - Phone:360-321-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist