Provider Demographics
NPI:1942421821
Name:JOHNS, SUSAN DEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DEAN
Last Name:JOHNS
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 1:443 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3635
Mailing Address - Country:US
Mailing Address - Phone:650-588-9668
Mailing Address - Fax:650-588-3230
Practice Address - Street 1:443 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3635
Practice Address - Country:US
Practice Address - Phone:650-588-9668
Practice Address - Fax:650-588-3230
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist