Healthcare Provider Details

I. General information

NPI: 1972019347
Provider Name (Legal Business Name): SUSAN K SHUMAKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W OLIVE ST STE 118
SCRANTON PA
18508-2576
US

IV. Provider business mailing address

3 W OLIVE ST STE 118
SCRANTON PA
18508-2576
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-3823
  • Fax: 570-207-5988
Mailing address:
  • Phone: 570-961-3823
  • Fax: 570-207-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE00633L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierTE000633L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: