MEDICARE: DR. ASHLEY NOEL SUSEN DPT

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	10908	NC

General Provider Information

NPI Number	:	1548317258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY NOEL SUSEN DPT

Provider Business Mailing Address
First Line	:	108A DUNES CT
Second Line	:
City	:	ATLANTIC BEACH
State	:	NC
Zip	:	28512-7424
Country	:	US
Telephone Number	:	828-450-1018
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 N 35TH ST
Second Line	:	SUITE D
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3182
Country	:	US
Telephone Number	:	252-726-1802
Fax Number	:	252-726-1805

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/07/2008

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