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General NPI Number Information
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NPI Number | 1437500998
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Entity Type | Organization
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Legal Business Name | SUSKO THERAPY LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 2800 MEMORIAL HWY SUITE 5
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City | DALLAS
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State | PA
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Zip | 18612-1569
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Country | US
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Telephone | 570-675-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 MEMORIAL HWY SUITE 5
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City | DALLAS
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State | PA
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Zip | 18612-1569
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Country | US
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Telephone | 570-675-1800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | MR. CHASE DANIEL SUSKO
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Credential | MSPT
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Telephone | 570-675-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT019621
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License Number State | PA
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