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General NPI Number Information
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NPI Number | 1144353434
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Entity Type | Individual
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Provider Name | SUSANNE WESEMEYER-ORTIZ PT
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | US HWY 64 OLD HIGH SCHOOL ROAD
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City | SHIPROCK
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State | NM
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Zip | 87420
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Country | US
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Telephone | 505-368-5163
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Fax | 505-368-5502
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Provider Business Mailing Address
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Address Line | 2150 LION'S TRAIL
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-327-6575
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1114
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License Number State | NM
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