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NPI Code Detail

MEDICARE: SUSAN L PENDER MPT

MEDICARE: SUSAN L PENDER MPT
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 TherapistMD
22251X0800XOrthopedic Physical TherapistJ1-0001738DE

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G00716OTHERDEPHYSIOTHERAPY ASSOCIATES MEDICARE PIN

General Provider Information

NPI Number : 1881789246
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN L PENDER MPT
Provider Business Mailing Address
First Line : 2001 BUTTERFIELD RD STE 1600
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1288 S GOVERNORS AVE
Second Line :
City : DOVER
State : DE
Zip : 19904-4802
Country : US
Telephone Number : 302-677-0100
Fax Number : 302-677-0267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 06/27/2025

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Directions to “ SUSAN L PENDER MPT” Practice Location

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