Provider Demographics
NPI:1285992453
Name:HARBOUR, SUSAN ALEXANDRA (MPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALEXANDRA
Last Name:HARBOUR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ALEXANDRA
Other - Last Name:BARLOEWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:18 AMBERHILL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602
Mailing Address - Country:US
Mailing Address - Phone:949-419-7563
Mailing Address - Fax:
Practice Address - Street 1:30252 TOMAS
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-459-1658
Practice Address - Fax:949-459-1667
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist