Provider Demographics
NPI:1205807807
Name:ARMSTRONG, SUSAN (MPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 N EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1942
Mailing Address - Country:US
Mailing Address - Phone:608-845-2100
Mailing Address - Fax:608-845-2101
Practice Address - Street 1:1049 N EDGE TRL
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1942
Practice Address - Country:US
Practice Address - Phone:608-845-2100
Practice Address - Fax:608-845-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9730-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40405400 34/065Medicaid
WI40405400 34/065Medicaid