Provider Demographics
NPI:1992117063
Name:FACEMIRE, SUSAN N (DPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:N
Last Name:FACEMIRE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:N
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:129 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4204
Mailing Address - Country:US
Mailing Address - Phone:330-631-0010
Mailing Address - Fax:330-631-0011
Practice Address - Street 1:129 5TH ST SE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4204
Practice Address - Country:US
Practice Address - Phone:330-631-0010
Practice Address - Fax:330-631-0011
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist