Provider Demographics
NPI:1972019347
Name:SHUMAKER, SUSAN K (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W OLIVE ST STE 118
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2576
Mailing Address - Country:US
Mailing Address - Phone:570-961-3823
Mailing Address - Fax:570-207-5988
Practice Address - Street 1:3 W OLIVE ST STE 118
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2576
Practice Address - Country:US
Practice Address - Phone:570-961-3823
Practice Address - Fax:570-207-5988
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE00633L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATE000633LOtherLICENSE