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General NPI Number Information
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NPI Number | 1043617426
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Entity Type | Individual
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Provider Name | SUSANNE CARVALHO DPT
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Gender | Female
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 30 PLATINUM CIR
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City | LADERA RANCH
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State | CA
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Zip | 92694-1348
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Country | US
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Telephone | 413-214-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 34024 SELVA RD UNIT 59
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City | DANA POINT
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State | CA
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Zip | 92629-3729
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Country | US
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Telephone | 413-214-3368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 41677
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License Number State | CA
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