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General NPI Number Information
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NPI Number | 1144826587
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Entity Type | Individual
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Provider Name | SUSAN PHANGRATH
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Gender | Female
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1250 NORTHWEST HWY STE G
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City | GARLAND
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State | TX
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Zip | 75041-5842
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Country | US
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Telephone | 972-698-0615
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Fax |
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Provider Business Mailing Address
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Address Line | 103 HERITAGE LN APT 312
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City | DENTON
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State | TX
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Zip | 76209-1936
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Country | US
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Telephone | 817-627-9823
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 80902
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License Number State | TX
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