Healthcare Provider Details

I. General information

NPI: 1255641437
Provider Name (Legal Business Name): SUSAN D ORGAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SYCAMORE DR SUITE 202
SIMI VALLEY CA
93065-1207
US

IV. Provider business mailing address

5460 BARNARD ST
SIMI VALLEY CA
93063-3575
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-3222
  • Fax: 805-582-2651
Mailing address:
  • Phone: 805-584-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 13270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: