Healthcare Provider Details

I. General information

NPI: 1841267655
Provider Name (Legal Business Name): SUSAN SMITH PT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N 11TH ST
PHILADELPHIA PA
19123-1957
US

IV. Provider business mailing address

245 N 15TH ST MS 502
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-769-1100
  • Fax:
Mailing address:
  • Phone: 215-762-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT016957
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: