Provider Demographics
NPI:1447647136
Name:BALLMAN, SUSAN MICHELLE ADDISON (MPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN MICHELLE
Middle Name:ADDISON
Last Name:BALLMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1337
Mailing Address - Country:US
Mailing Address - Phone:301-452-4633
Mailing Address - Fax:
Practice Address - Street 1:10901 RIVERWOOD DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1337
Practice Address - Country:US
Practice Address - Phone:301-452-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192122251P0200X
DCPT8713582251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics