Healthcare Provider Details

I. General information

NPI: 1902004328
Provider Name (Legal Business Name): SUSAN NANETTE CUZZORT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 W GORE BLVD SUITE A-1
LAWTON OK
73505-5977
US

IV. Provider business mailing address

7708 NW WYCLIFFE LN
LAWTON OK
73505-4031
US

V. Phone/Fax

Practice location:
  • Phone: 580-585-5575
  • Fax: 580-585-5597
Mailing address:
  • Phone: 580-536-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3093
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: