Provider Demographics
NPI:1124436696
Name:FRENCH, SUSAN (PTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FRENCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-1418
Mailing Address - Country:US
Mailing Address - Phone:609-516-4015
Mailing Address - Fax:
Practice Address - Street 1:2305 RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4113
Practice Address - Country:US
Practice Address - Phone:609-747-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB0248200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant