Provider Demographics
NPI:1174514947
Name:DEANA, SUSIE (PT)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:DEANA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:FLIGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-4500
Mailing Address - Fax:978-834-7229
Practice Address - Street 1:110 HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2123
Practice Address - Country:US
Practice Address - Phone:978-388-4500
Practice Address - Fax:978-834-7229
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68581Medicare ID - Type Unspecified