Provider Demographics
NPI:1366738437
Name:PERRY-DOUCETTE, SUSAN B (PTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:PERRY-DOUCETTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13186 PIRATE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4167
Mailing Address - Country:US
Mailing Address - Phone:352-684-8512
Mailing Address - Fax:727-499-7887
Practice Address - Street 1:13186 PIRATE LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-4167
Practice Address - Country:US
Practice Address - Phone:352-684-8512
Practice Address - Fax:727-499-7887
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20103225200000X
MA2279225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant