Provider Demographics
NPI:1346338464
Name:HUFFMAN, SUSAN POLAND (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:POLAND
Last Name:HUFFMAN
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:PO BOX 5538
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-5538
Mailing Address - Country:US
Mailing Address - Phone:904-808-7351
Mailing Address - Fax:
Practice Address - Street 1:2706 OLD MOULTRIE RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5447
Practice Address - Country:US
Practice Address - Phone:904-794-6760
Practice Address - Fax:904-794-6760
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 12766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9175OtherBLUE CROSS BLUE SHIELD FL
FLP00144956Medicare ID - Type UnspecifiedMEDICARE RAILROAD
FLY9175OtherBLUE CROSS BLUE SHIELD FL