Provider Demographics
NPI:1942259502
Name:PADEZANIN, SUSAN CARMEN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CARMEN
Last Name:PADEZANIN
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 1:7979 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9383
Mailing Address - Country:US
Mailing Address - Phone:910-686-6845
Mailing Address - Fax:910-686-6837
Practice Address - Street 1:7979 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9383
Practice Address - Country:US
Practice Address - Phone:910-686-6845
Practice Address - Fax:910-686-6837
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2500117Medicare ID - Type Unspecified