Provider Demographics
NPI:1750377644
Name:WEBSTER, SUSAN ELAINE (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:WEBSTER
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 1:845 WATER ST
Mailing Address - Street 2:PO BOX 64
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-1243
Mailing Address - Country:US
Mailing Address - Phone:570-473-3912
Mailing Address - Fax:570-473-8731
Practice Address - Street 1:845 WATER ST
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-1243
Practice Address - Country:US
Practice Address - Phone:570-473-3912
Practice Address - Fax:570-473-8731
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002384E208100000X
PADAPT000338208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50041977OtherCAPITAL BLUE CROSS
PA50041977OtherCAPITAL BLUE CROSS
PA032559Medicare ID - Type Unspecified