Provider Demographics
NPI:1952655086
Name:STEPHEN, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAGGIES POND RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05841-8800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 MAGGIES POND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:VT
Practice Address - Zip Code:05841-8800
Practice Address - Country:US
Practice Address - Phone:802-533-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0000897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist