Provider Demographics
NPI:1063962108
Name:RHEAULT, SUZAN
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:RHEAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KEEWAYDIN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2839
Mailing Address - Country:US
Mailing Address - Phone:800-955-6273
Mailing Address - Fax:888-979-6551
Practice Address - Street 1:2 KEEWAYDIN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2839
Practice Address - Country:US
Practice Address - Phone:800-955-6273
Practice Address - Fax:888-979-6551
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYP1707225100000X
MTPTP-PT-LIC-6221225100000X
MA7015225100000X
IDPT-1966225100000X
WAPT6023715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist