Provider Demographics
NPI:1063452951
Name:REAGAN, SUSAN MARIE (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:REAGAN
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:PO BOX 3340
Mailing Address - Street 2:NEW VALLEY REHAB
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18043-3340
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:518 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2404
Practice Address - Country:US
Practice Address - Phone:610-967-0770
Practice Address - Fax:610-966-6105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005729L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01604660Medicaid
635050OtherPPO PERSONAL CHOICE
PT005729LOtherUS DEPT OF LABOR
0465115000OtherHMO KEYSTONE EAST
PARE635050OtherHIGHMARK
PA50018508OtherCAPITAL
PARE635050OtherHIGHMARK