Provider Demographics
NPI:1881872521
Name:RYERSON, SUSAN J (PT, SCD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:RYERSON
Suffix:
Gender:F
Credentials:PT, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S MAPLE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4246
Mailing Address - Country:US
Mailing Address - Phone:703-370-2970
Mailing Address - Fax:
Practice Address - Street 1:410 S MAPLE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4246
Practice Address - Country:US
Practice Address - Phone:703-370-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050009262251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491154Medicare PIN