1497830517 NPI number — MRS. SUSAN DIANE KURTZ PHYSICAL THERAPIST R

Table of content: MRS. SUSAN DIANE KURTZ PHYSICAL THERAPIST R (NPI 1497830517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497830517 NPI number — MRS. SUSAN DIANE KURTZ PHYSICAL THERAPIST R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTZ
Provider First Name:
SUSAN
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MECHAM
Provider Other First Name:
SUSAN
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST R
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497830517
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:
4005 THAMES COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-834-6540
Provider Business Mailing Address Fax Number:
661-869-2726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 MT VERNON
Provider Second Line Business Practice Location Address:
2ND FLOOR MCKINLEY MTU CO KERN COUNTY DEPT OF PUBLIC HE
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93306-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-868-7270
Provider Business Practice Location Address Fax Number:
661-869-2726
Provider Enumeration Date:
10/26/2006

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:  PT5585 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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