Provider Demographics
NPI:1912056201
Name:SUSI, JOSEPH D II (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:SUSI
Suffix:II
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2306 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1210
Mailing Address - Country:US
Mailing Address - Phone:906-635-2161
Mailing Address - Fax:906-635-2753
Practice Address - Street 1:650 W EASTERDAY AVE
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1656
Practice Address - Country:US
Practice Address - Phone:906-635-2161
Practice Address - Fax:906-635-2753
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer