Provider Demographics
NPI:1295979722
Name:CAFFARELLA-SIMONSON, SUSAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CAFFARELLA-SIMONSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4314
Mailing Address - Country:US
Mailing Address - Phone:610-446-5547
Mailing Address - Fax:
Practice Address - Street 1:317 GREENVIEW LN
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4314
Practice Address - Country:US
Practice Address - Phone:610-446-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011992L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT011992LOtherCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE