Provider Demographics
NPI:1356416473
Name:KLINGER, SUE ANN (PT)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:KLINGER
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 1:10701 ALLIANCE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8836
Mailing Address - Country:US
Mailing Address - Phone:317-821-3740
Mailing Address - Fax:317-821-3750
Practice Address - Street 1:10701 ALLIANCE DR
Practice Address - Street 2:SUITE D
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8836
Practice Address - Country:US
Practice Address - Phone:317-821-3740
Practice Address - Fax:317-821-3750
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000924A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156529Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER