Provider Demographics
NPI:1386746170
Name:DECKER, SUSAN CHRISTINE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:DECKER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ORANGE AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-5202
Mailing Address - Country:US
Mailing Address - Phone:407-236-7155
Mailing Address - Fax:
Practice Address - Street 1:801 N ORANGE AVE STE 610
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801
Practice Address - Country:US
Practice Address - Phone:407-236-7155
Practice Address - Fax:407-236-7441
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010297225100000X
FLPT30715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4194182Medicare PIN
OH4194181Medicare PIN