Provider Demographics
NPI:1255565362
Name:FICKEN, SUSAN LYNNE (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNNE
Last Name:FICKEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 STAIR LN
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-4406
Mailing Address - Country:US
Mailing Address - Phone:570-646-6071
Mailing Address - Fax:
Practice Address - Street 1:109 STAIR LN
Practice Address - Street 2:
Practice Address - City:SHOHOLA
Practice Address - State:PA
Practice Address - Zip Code:18458-4406
Practice Address - Country:US
Practice Address - Phone:570-646-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006265L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics