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General NPI Number Information
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NPI Number | 1679054654
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Entity Type | Individual
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Provider Name | SUSAN ELSIE SANCHEZ-KULURIS PT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 3 PURSUIT
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4213
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Country | US
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Telephone | 949-389-8516
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 SE INTERNATIONAL WAY STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97222-4628
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12778
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License Number State | CA
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