Provider Demographics
NPI:1205001450
Name:ROY, SUSAN W (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:ROY
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 1:827 UNION PACIFIC BLVD
Mailing Address - Street 2:PMB 71-29
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-9484
Mailing Address - Country:US
Mailing Address - Phone:877-446-0663
Mailing Address - Fax:
Practice Address - Street 1:827 UNION PACIFIC BLVD
Practice Address - Street 2:PMB 71-29
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-9484
Practice Address - Country:US
Practice Address - Phone:877-446-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist