1477688562 NPI number — MRS. SUSAN RITA SANNELLA FLEMING PT,DPT

Table of content: MRS. SUSAN RITA SANNELLA FLEMING PT,DPT (NPI 1477688562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477688562 NPI number — MRS. SUSAN RITA SANNELLA FLEMING PT,DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANNELLA FLEMING
Provider First Name:
SUSAN
Provider Middle Name:
RITA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT,DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLEMING
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477688562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 W HANCOCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONEHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02180-3116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-438-8571
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 EVERETT AVE
Provider Second Line Business Practice Location Address:
MGH CHELSEA HEALTHCARE CENTER PHYSICAL THERAPY DEPT.
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02150-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-887-3586
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9116 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9116 . This is a "MA LICENSURE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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