Provider Demographics
NPI:1063548543
Name:RETHLEFSEN, SUSAN ANN (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:RETHLEFSEN
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 1:4650 W SUNSET BLVD MSC 69
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-669-4120
Mailing Address - Fax:323-666-4409
Practice Address - Street 1:4650 W SUNSET BLVD MSC 69
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-4120
Practice Address - Fax:323-666-4409
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212251E1300X
CA130002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics