Provider Demographics
NPI:1780255364
Name:LONG, SUSAN ANNETTE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNETTE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MULLIGAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FLORENCE
Mailing Address - State:PA
Mailing Address - Zip Code:15944-9541
Mailing Address - Country:US
Mailing Address - Phone:814-244-6665
Mailing Address - Fax:
Practice Address - Street 1:210 INDUSTRIAL PARK RD STE 140
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1948
Practice Address - Country:US
Practice Address - Phone:814-534-7500
Practice Address - Fax:814-534-7501
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007101L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist