Provider Demographics
NPI:1902974587
Name:MCGINTY, SUSAN MAE (PT, EDD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAE
Last Name:MCGINTY
Suffix:
Gender:F
Credentials:PT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3719
Mailing Address - Country:US
Mailing Address - Phone:916-451-0858
Mailing Address - Fax:
Practice Address - Street 1:6000 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2605
Practice Address - Country:US
Practice Address - Phone:916-278-5056
Practice Address - Fax:916-278-5053
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 2186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist