Provider Demographics
NPI:1982896098
Name:FELDMAN, SUSAN LYNN (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3413
Mailing Address - Country:US
Mailing Address - Phone:979-245-0300
Mailing Address - Fax:979-245-4010
Practice Address - Street 1:1221 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3413
Practice Address - Country:US
Practice Address - Phone:979-245-0300
Practice Address - Fax:979-245-4010
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130126Medicare PIN