MEDICARE: MS. SUSAN CONROY

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	15457	CA

General Provider Information

NPI Number	:	1447503719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN CONROY

Provider Business Mailing Address
First Line	:	6441 CRANDALL DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6441 CRANDALL DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4205
Country	:	US
Telephone Number	:	714-469-3919
Fax Number	:

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

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	10/24/2012

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