Basic Information
| Provider Information | |||||||||
| NPI: | 1275132250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OZOG | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JOSEPHINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91 HILLDALE RD | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017211633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197574702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 904C BOSTON TPKE | ||||||||
| Address2: | |||||||||
| City: | SHREWSBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015453303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088453500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 25183 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.