Provider Demographics
NPI:1982051025
Name:ELIAS, SUSAN ROWE (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROWE
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:848 FIFE WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3528
Mailing Address - Country:US
Mailing Address - Phone:408-507-0516
Mailing Address - Fax:408-647-2781
Practice Address - Street 1:848 FIFE WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3528
Practice Address - Country:US
Practice Address - Phone:408-507-0516
Practice Address - Fax:408-647-2781
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist