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General NPI Number Information
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NPI Number | 1194045658
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Entity Type | Individual
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Provider Name | SUSAN MAACK PTA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 1390 KING TREE DR
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City | DAYTON
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State | OH
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Zip | 45405-1401
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Country | US
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Telephone | 937-279-2711
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Fax |
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Provider Business Mailing Address
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Address Line | 4492 SUMMIT RIDGE DR
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City | DAYTON
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State | OH
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Zip | 45424-4477
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Country | US
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Telephone | 937-235-0490
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5600
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License Number State | OH
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