Provider Demographics
NPI:1447289764
Name:SMITH, SUSAN E (ATC LAT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1403 CARAQUET DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2686
Mailing Address - Country:US
Mailing Address - Phone:281-419-2218
Mailing Address - Fax:
Practice Address - Street 1:16713 ELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4213
Practice Address - Country:US
Practice Address - Phone:281-586-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer