=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881889665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSANNA H NEMETH PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2007
-----------------------------------------------------
Last Update Date | 09/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 PASTEUR DR
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-723-6701
-----------------------------------------------------
Fax | 650-498-6982
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 PASTEUR DR
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-723-6701
-----------------------------------------------------
Fax | 650-498-6982
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 2415
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------