Provider Demographics
NPI:1316118565
Name:HUSTON, SUSAN KAY (MPT)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:KAY
Last Name:HUSTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:5640 SOUTHWYCK BLVD
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1569
Mailing Address - Country:US
Mailing Address - Phone:877-511-9739
Mailing Address - Fax:419-745-8819
Practice Address - Street 1:6495 E BROAD ST
Practice Address - Street 2:SUITE E/F
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-1541
Practice Address - Country:US
Practice Address - Phone:877-511-9739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH011388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4287981Medicare PIN