Provider Demographics
NPI:1174648984
Name:ARENTZ, SUSAN NANCY (PTA08)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:NANCY
Last Name:ARENTZ
Suffix:
Gender:F
Credentials:PTA08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 PENNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1422
Mailing Address - Country:US
Mailing Address - Phone:610-406-0259
Mailing Address - Fax:
Practice Address - Street 1:450 EAST PHILADELPHIA AVE.
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607
Practice Address - Country:US
Practice Address - Phone:610-796-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000763L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant