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General NPI Number Information
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NPI Number | 1174554828
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Entity Type | Individual
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Provider Name | SUSAN M SJOBERG PT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 96 HOULTON ROAD
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City | PRESQUE ISLE
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State | ME
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Zip | 04769
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Country | US
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Telephone | 207-764-6242
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Fax | 207-764-6242
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Provider Business Mailing Address
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Address Line | PO BOX 4063
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-4063
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Country | US
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Telephone | 207-764-6242
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 720
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License Number State | ME
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