Provider Demographics
NPI:1952517559
Name:CHURCHILL, SUSAN CLAUDIA (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CLAUDIA
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2207
Mailing Address - Country:US
Mailing Address - Phone:360-738-3013
Mailing Address - Fax:
Practice Address - Street 1:3121 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1937
Practice Address - Country:US
Practice Address - Phone:360-752-6340
Practice Address - Fax:360-752-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0217302OtherLABOR AND INDUSTRIES