Basic Information
| Provider Information | |||||||||
| NPI: | 1235568510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYERSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RAMSEY | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | E | ||||||||
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| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9455 LORTON MARKET ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220791962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039713701 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9455 LORTON MARKET ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220791962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039713701 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2013 | ||||||||
| LastUpdateDate: | 11/06/2013 | ||||||||
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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 | 225200000X | 23061007 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.