Provider Demographics
NPI:1982429437
Name:TOWNSEND, SUSAN MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:LARUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4718 HANNAFORD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3900
Mailing Address - Country:US
Mailing Address - Phone:419-377-8106
Mailing Address - Fax:
Practice Address - Street 1:4718 HANNAFORD DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3900
Practice Address - Country:US
Practice Address - Phone:419-377-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant