1568787935 NPI number — SUSAN M GUENARD M.S., P.T.

Table of content: SUSAN M GUENARD M.S., P.T. (NPI 1568787935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568787935 NPI number — SUSAN M GUENARD M.S., P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUENARD
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568787935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 CONVERSE ST.
Provider Second Line Business Mailing Address:
JEWISH NURSING HOME
Provider Business Mailing Address City Name:
LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01106-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-567-6211
Provider Business Mailing Address Fax Number:
413-567-2477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 CONVERSE ST
Provider Second Line Business Practice Location Address:
JEWISH NURSING HOME
Provider Business Practice Location Address City Name:
LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01106-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-567-6211
Provider Business Practice Location Address Fax Number:
413-567-2477
Provider Enumeration Date:
03/29/2010

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:  8418 , 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)