Provider Demographics
NPI:1063421667
Name:HAUSHEER, SUSAN Y (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:Y
Last Name:HAUSHEER
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 1:1904 NW HEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-7214
Mailing Address - Country:US
Mailing Address - Phone:816-220-3700
Mailing Address - Fax:816-220-0946
Practice Address - Street 1:701 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-8102
Practice Address - Country:US
Practice Address - Phone:816-690-8516
Practice Address - Fax:816-690-6252
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20230014OtherBCBS KC
266552Medicare ID - Type Unspecified