Provider Demographics
NPI:1841631678
Name:MCLAIN, SUSAN CAMPBELL (MSPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAMPBELL
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3165 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1563
Mailing Address - Country:US
Mailing Address - Phone:757-721-4675
Mailing Address - Fax:
Practice Address - Street 1:818 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1116
Practice Address - Country:US
Practice Address - Phone:757-473-8016
Practice Address - Fax:757-473-3580
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist