Basic Information
| Provider Information | |||||||||
| NPI: | 1043935091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANGE | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 N EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920241320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606326942 | ||||||||
| FaxNumber: | 7606326819 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 N EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920241320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606326942 | ||||||||
| FaxNumber: | 7606326819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 302890 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.