Provider Demographics
NPI:1043617426
Name:CARVALHO, SUSANNE (DPT)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:CARVALHO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34024 SELVA RD UNIT 59
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3729
Mailing Address - Country:US
Mailing Address - Phone:413-214-3368
Mailing Address - Fax:
Practice Address - Street 1:30 PLATINUM CIR
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1348
Practice Address - Country:US
Practice Address - Phone:413-214-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41677225100000X
NY037238-1225100000X
MA20937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist