MEDICARE: SUSANNE ELIZABETH MCINTOSH 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	PT 5639	FL

General Provider Information

NPI Number	:	1609944891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNE ELIZABETH MCINTOSH P.T.

Provider Business Mailing Address
First Line	:	3603 SE 9TH PL
Second Line	:	#6
City	:	CAPE CORAL
State	:	FL
Zip	:	33904
Country	:	US
Telephone Number	:	239-699-8795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 VISCAYA PKWY
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-6206
Country	:	US
Telephone Number	:	239-242-9970
Fax Number	:	239-242-0076

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/08/2016

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