Provider Demographics
NPI:1396794822
Name:SCHIMKE, SUSAN LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:SCHIMKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2924 OLD OAK TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5502
Mailing Address - Country:US
Mailing Address - Phone:916-315-9951
Mailing Address - Fax:
Practice Address - Street 1:2924 OLD OAK TREE WAY
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5502
Practice Address - Country:US
Practice Address - Phone:916-315-9951
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist