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General NPI Number Information
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NPI Number | 1861558942
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Entity Type | Individual
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Provider Name | MS. SUSAN SMITH
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Gender | Female
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 170 CHANGEBRIDGE RD SUITE A5
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City | MONTVILLE
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State | NJ
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Zip | 07045-9115
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Country | US
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Telephone | 973-575-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 20 OPING RD
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City | POMPTON PLAINS
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State | NJ
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Zip | 07444-1417
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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 | 40QA00265800
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License Number State | NJ
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