MEDICARE: SUSIE FALTZ

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	347C00000X	Private Vehicle	T65520517	VA

General Provider Information

NPI Number	:	1831684182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSIE FALTZ

Provider Business Mailing Address
First Line	:	208 DEER SPRING LN
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-2942
Country	:	US
Telephone Number	:	757-357-0809
Fax Number	:	757-357-0809

Provider Business Practice Location Address
First Line	:	208 DEER SPRING LN
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-2942
Country	:	US
Telephone Number	:	757-357-0809
Fax Number	:	757-357-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	06/28/2018

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Directions to “ SUSIE FALTZ ” Practice Location

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