Provider Demographics
NPI:1912061441
Name:HOUT, SUSAN JORALEMON (PT, MED)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JORALEMON
Last Name:HOUT
Suffix:
Gender:F
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 VALLEY RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6335
Mailing Address - Country:US
Mailing Address - Phone:928-708-0841
Mailing Address - Fax:
Practice Address - Street 1:3343 N WINDSONG DR STE 5
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1213
Practice Address - Country:US
Practice Address - Phone:928-759-5591
Practice Address - Fax:928-759-5593
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ409989Medicaid