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General NPI Number Information
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NPI Number | 1790903284
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Entity Type | Individual
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Provider Name | SUSAN THERESE CHARLWOOD PT, MSW
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34 DANIELSON PIKE SUITE D
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City | NORTH SCITUATE
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State | RI
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Zip | 02857-1802
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Country | US
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Telephone | 401-647-4455
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Fax | 401-647-4456
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Provider Business Mailing Address
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Address Line | 58 E KILLINGLY RD
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City | FOSTER
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State | RI
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Zip | 02825-1428
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Country | US
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Telephone | 401-647-2975
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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 | PT00157
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1602
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License Number State | MA
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