Provider Demographics
NPI:1831684182
Name:FALTZ, SUSIE
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:FALTZ
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 1:208 DEER SPRING LN
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-2942
Mailing Address - Country:US
Mailing Address - Phone:757-357-0809
Mailing Address - Fax:757-357-0809
Practice Address - Street 1:208 DEER SPRING LN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-2942
Practice Address - Country:US
Practice Address - Phone:757-357-0809
Practice Address - Fax:757-357-0809
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT65520517347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle