MEDICARE: SUSKO THERAPY LLC

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
1	261QP2000X	Physical Therapy Clinic/Center	PT019621	PA

General Provider Information

NPI Number	:	1437500998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSKO THERAPY LLC

Provider Business Mailing Address
First Line	:	2800 MEMORIAL HWY
Second Line	:	SUITE 5
City	:	DALLAS
State	:	PA
Zip	:	18612-1569
Country	:	US
Telephone Number	:	570-675-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 MEMORIAL HWY
Second Line	:	SUITE 5
City	:	DALLAS
State	:	PA
Zip	:	18612-1569
Country	:	US
Telephone Number	:	570-675-1800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PHYSICAL THERAPIST
Name	:	MR. CHASE DANIEL SUSKO
Credential	:	MSPT
Telephone Number	:	570-675-1800

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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Directions to “SUSKO THERAPY LLC ” Practice Location

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