Provider Demographics
NPI:1750420295
Name:REISCHL, SUSAN KELLER (PT, OCS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KELLER
Last Name:REISCHL
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2309
Mailing Address - Country:US
Mailing Address - Phone:562-427-2225
Mailing Address - Fax:562-427-5656
Practice Address - Street 1:3292 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2309
Practice Address - Country:US
Practice Address - Phone:562-427-2225
Practice Address - Fax:562-427-5656
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18744Medicare ID - Type UnspecifiedSPECIALIST