Provider Demographics
NPI:1912934225
Name:GREENE, SUSAN APPLEBY (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:APPLEBY
Last Name:GREENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:APPLEBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1670 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4004
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:#117
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-5002
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist