Healthcare Provider Details

I. General information

NPI: 1568862696
Provider Name (Legal Business Name): SUSAN E ORESHACK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 12/25/2023
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 N 28TH DR STE F100
PHOENIX AZ
85029-5606
US

IV. Provider business mailing address

4715 N 32ND ST SUITE 108
PHOENIX AZ
85018-3300
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-0066
  • Fax:
Mailing address:
  • Phone: 480-689-5520
  • Fax: 480-706-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11131
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: