Healthcare Provider Details

I. General information

NPI: 1366738437
Provider Name (Legal Business Name): SUSAN B PERRY-DOUCETTE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13186 PIRATE LN
SPRING HILL FL
34609-4167
US

IV. Provider business mailing address

13186 PIRATE LN
SPRING HILL FL
34609-4167
US

V. Phone/Fax

Practice location:
  • Phone: 352-684-8512
  • Fax: 727-499-7887
Mailing address:
  • Phone: 352-684-8512
  • Fax: 727-499-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20103
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: