Provider Demographics
NPI:1962510354
Name:SOBKOWICH, SUSAN M (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SOBKOWICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:SODERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:951 BROKEN SOUND PKWY NW
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-372-0214
Practice Address - Street 1:5365 W ATLANTIC AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8172
Practice Address - Country:US
Practice Address - Phone:561-495-6300
Practice Address - Fax:561-495-8877
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT7590OtherFLORIDA LICENSE
FLU6621XMedicare PIN