=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972612851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN CAROL JOSEPH PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 03/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2629 W SR 434
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-774-1716
-----------------------------------------------------
Fax | 407-774-9527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2629 W. SR 434
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-869-8214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | PT0002774
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------