Basic Information
| Provider Information | |||||||||
| NPI: | 1285946681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNINGER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 N ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644554379 | ||||||||
| FaxNumber: | 8643311446 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 N ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644554379 | ||||||||
| FaxNumber: | 8643311446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT.6212 PT | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT.6212 PT | 01 | SC | PHYSICAL THERAPY LICENSE | OTHER |