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NPI Code Detail

MEDICARE: MRS. SUSAN B RABOURN P. T.

MEDICARE:  MRS. SUSAN B RABOURN  P. T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 34988CA
22251G0304XGeriatric Physical TherapistPT 34988CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT 34988OTHERCAPHYSICAL THERAPIST LICENSE
21062OTHERNCPHYSICAL THERAPIST LICENSE

General Provider Information

NPI Number : 1083866495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN B RABOURN P. T.
Provider Business Mailing Address
First Line : PO BOX 222300
Second Line :
City : CARMEL
State : CA
Zip : 93922-2300
Country : US
Telephone Number : 831-659-1946
Fax Number :
Provider Business Practice Location Address
First Line : 245 CROSSROADS BLVD
Second Line :
City : CARMEL
State : CA
Zip : 93923-8650
Country : US
Telephone Number : 831-620-0744
Fax Number : 831-620-0711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2008
Last Update Date : 10/16/2008

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Directions to “ MRS. SUSAN B RABOURN P. T.” Practice Location

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