Provider Demographics
NPI:1487767679
Name:LENDICH, SUSAN MARIELA (RPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIELA
Last Name:LENDICH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 WELLINGTON WAY SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968
Mailing Address - Country:US
Mailing Address - Phone:954-588-5789
Mailing Address - Fax:
Practice Address - Street 1:2685 EXECUTIVE PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3651
Practice Address - Country:US
Practice Address - Phone:954-515-0892
Practice Address - Fax:954-349-0896
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 0006159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885532300Medicaid