Provider Demographics
NPI:1700301975
Name:KROUSE, SUSANNA GRACE (DPT)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:GRACE
Last Name:KROUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:GRACE
Other - Last Name:POLLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:208 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1538
Practice Address - Country:US
Practice Address - Phone:706-234-8221
Practice Address - Fax:706-291-9647
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist