Provider Demographics
NPI:1619969367
Name:DOWNEY, SUSAN R (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:NCCANDLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11019 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3001
Practice Address - Country:US
Practice Address - Phone:253-286-3600
Practice Address - Fax:253-286-3444
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192086OtherDEPT OF L&I
WA8368979Medicaid
WA5882DOOtherREGENCE BS
WA8939556OtherCRIME VICTIMS
WA5882DOOtherREGENCE BS