Provider Demographics
NPI:1306067855
Name:EDMOND, SUSAN LEIGH (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEIGH
Last Name:EDMOND
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 1:43 ELMWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3320
Mailing Address - Country:US
Mailing Address - Phone:973-379-4377
Mailing Address - Fax:
Practice Address - Street 1:43 ELMWOOD PL
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-3320
Practice Address - Country:US
Practice Address - Phone:973-379-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00204700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist