Provider Demographics
NPI:1124353792
Name:WISE, SUSAN CAULFIELD (MSPT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAULFIELD
Last Name:WISE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:CAULFIELD
Other - Last Name:SCHATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7405 CALICO CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1302
Mailing Address - Country:US
Mailing Address - Phone:703-455-1660
Mailing Address - Fax:
Practice Address - Street 1:7405 CALICO CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1302
Practice Address - Country:US
Practice Address - Phone:703-455-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052044782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics