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NPI Code Detail

MEDICARE: MS. SUSAN MOLDT PTA

MEDICARE: MS. SUSAN MOLDT PTA
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
1225200000XPhysical Therapy Assistant40QB00109100NJ

General Provider Information

NPI Number : 1164546354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN MOLDT PTA
Provider Business Mailing Address
First Line : 44 ALLAN DR
Second Line :
City : NORTH ARLINGTON
State : NJ
Zip : 07031-5147
Country : US
Telephone Number : 201-998-4403
Fax Number :
Provider Business Practice Location Address
First Line : 25 E LINDSLEY RD
Second Line :
City : CEDAR GROVE
State : NJ
Zip : 07009-1023
Country : US
Telephone Number : 973-256-7220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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