Provider Demographics
NPI:1457963654
Name:ALDRICH, SUSAN H (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:ALDRICH
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 1:39 CACHE CAY DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1211
Mailing Address - Country:US
Mailing Address - Phone:772-538-2109
Mailing Address - Fax:
Practice Address - Street 1:39 CACHE CAY DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1211
Practice Address - Country:US
Practice Address - Phone:772-538-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0006631225100000X
IL070.003115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist