Provider Demographics
NPI:1942327044
Name:MCINTYRE, SUSAN TAMARA (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:TAMARA
Last Name:MCINTYRE
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 1:2249 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2731
Mailing Address - Country:US
Mailing Address - Phone:610-649-3247
Mailing Address - Fax:
Practice Address - Street 1:146 MARPLE RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2040
Practice Address - Country:US
Practice Address - Phone:610-356-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005853L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist