Provider Demographics
NPI:1457690869
Name:WALTHAUS, SUSAN HENARD (PT, MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HENARD
Last Name:WALTHAUS
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 TORO RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36344-1459
Mailing Address - Country:US
Mailing Address - Phone:334-588-3842
Mailing Address - Fax:334-588-0514
Practice Address - Street 1:217 TORO RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AL
Practice Address - Zip Code:36344-1459
Practice Address - Country:US
Practice Address - Phone:334-588-3842
Practice Address - Fax:334-588-0514
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist