Provider Demographics
NPI:1245447598
Name:HOOVER, SUSAN VALERIE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VALERIE
Last Name:HOOVER
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:PO BOX 590
Mailing Address - Street 2:600 WEST 21 STREET
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0590
Mailing Address - Country:US
Mailing Address - Phone:406-446-1112
Mailing Address - Fax:
Practice Address - Street 1:600 WEST 21 STREET
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-0590
Practice Address - Country:US
Practice Address - Phone:406-446-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist