Healthcare Provider Details

I. General information

NPI: 1568658722
Provider Name (Legal Business Name): SUSANNE Q CRUPI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 CARTHAGE ST KINETIC INSTITUTE PHYSICAL THERAPY
SANFORD NC
27330
US

IV. Provider business mailing address

1210 CARTHAGE ST KINETIC INSTITUTE PHYSICAL THERAPY
SANFORD NC
27330
US

V. Phone/Fax

Practice location:
  • Phone: 919-776-5488
  • Fax: 919-776-8224
Mailing address:
  • Phone: 919-776-5488
  • Fax: 919-776-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10028
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: