Provider Demographics
NPI:1386976868
Name:VAN ORDEN, SUSAN HELE (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HELE
Last Name:VAN ORDEN
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 161
Mailing Address - Street 2:
Mailing Address - City:COMO
Mailing Address - State:CO
Mailing Address - Zip Code:80432-0161
Mailing Address - Country:US
Mailing Address - Phone:719-836-2046
Mailing Address - Fax:
Practice Address - Street 1:548 C FRONT STREET
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-1833
Practice Address - Fax:719-836-3346
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist