Provider Demographics
NPI:1215511878
Name:NEECE, SUSAN A (PTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:NEECE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:SCHMOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:115 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1615
Mailing Address - Country:US
Mailing Address - Phone:570-772-8561
Mailing Address - Fax:
Practice Address - Street 1:1900 RAVINE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2066
Practice Address - Country:US
Practice Address - Phone:570-323-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003439225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant