Provider Demographics
NPI:1598807562
Name:HILLMAN, SUSAN KAY (ATC, PT)
Entity type:Individual
Prefix:PROF
First Name:SUSAN
Middle Name:KAY
Last Name:HILLMAN
Suffix:
Gender:F
Credentials:ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 S PORT DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6716
Mailing Address - Country:US
Mailing Address - Phone:480-219-5235
Mailing Address - Fax:
Practice Address - Street 1:449 S PORT DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-6716
Practice Address - Country:US
Practice Address - Phone:480-219-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1046225100000X
CA11155225100000X
AZ01992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer