MEDICARE: SUSAN KOO P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT16296	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144232034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KOO P.T.

Provider Business Mailing Address
First Line	:	10470 OLD PLACERVILLE RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2539
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 PIONEER AVE
Second Line	:	SUITE 200
City	:	WOODLAND
State	:	CA
Zip	:	95776-4905
Country	:	US
Telephone Number	:	530-406-5620
Fax Number	:	530-406-5622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/29/2015

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Directions to “ SUSAN KOO P.T.” Practice Location

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