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General NPI Number Information
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NPI Number | 1104029255
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Entity Type | Individual
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Provider Name | SUSANNE ELIZABETH THOM PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1450 CLOVERFIELD ROAD
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-828-6584
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Fax |
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Provider Business Mailing Address
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Address Line | 1522 EUCLID STREET #19
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-576-6030
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Fax | 310-453-3373
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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 | 14858
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License Number State | CA
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