Basic Information
| Provider Information | |||||||||
| NPI: | 1063962108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHEAULT | ||||||||
| FirstName: | SUZAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 KEEWAYDIN DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030792839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009556273 | ||||||||
| FaxNumber: | 8889796551 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 KEEWAYDIN DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030792839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009556273 | ||||||||
| FaxNumber: | 8889796551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2016 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTP-PT-LIC-6221 | MT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 7015 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT-1966 | ID | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PHYP1707 | AK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT6023715 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.