Provider Demographics
NPI:1770157372
Name:FLANAGAN, SUSAN R (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:FLANAGAN
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 1:123 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2450
Mailing Address - Country:US
Mailing Address - Phone:860-509-3780
Mailing Address - Fax:
Practice Address - Street 1:123 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2450
Practice Address - Country:US
Practice Address - Phone:860-509-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002961261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy