Provider Demographics
NPI:1750071197
Name:SPARKS-CAHILL, SUSAN ANN (PTA DEJ2-0000877)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:SPARKS-CAHILL
Suffix:
Gender:F
Credentials:PTA DEJ2-0000877
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1606
Mailing Address - Country:US
Mailing Address - Phone:856-275-6715
Mailing Address - Fax:
Practice Address - Street 1:10 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1606
Practice Address - Country:US
Practice Address - Phone:856-275-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-00008772251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty