Provider Demographics
NPI:1932244308
Name:LEFEVER, SUSAN LYNN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:LEFEVER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LEFEVER BUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-1845
Mailing Address - Country:US
Mailing Address - Phone:360-378-4112
Mailing Address - Fax:360-378-4655
Practice Address - Street 1:689-A AIRPORT CENTER ROAD
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-4112
Practice Address - Fax:360-378-4655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7087745Medicaid
WA13559OtherREGENCE BLUE SHIELD
WA0077327OtherLABOR & INDUSTRIES
WA1353851OtherBLUE CROSS
WA396235001OtherGROUP HEALTH COOPERATIVE
WA7087745Medicaid
F08397Medicare UPIN