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NPI Code Detail

MEDICARE: SUSAN MOTTS PT

MEDICARE: SUSAN MOTTS PT
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
1225100000XPhysical Therapist3373AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13373OTHERARPT LICENSE

General Provider Information

NPI Number : 1326038837
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MOTTS PT
Provider Business Mailing Address
First Line : PO BOX 910
Second Line : PHYSICAL THERAPY DEPARTMENT
City : STATE UNIVERSITY
State : AR
Zip : 72467-0910
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3131 TOM AUSTIN HWY
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-4801
Country : US
Telephone Number : 870-972-3591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 11/06/2012

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