Provider Demographics
NPI:1538227533
Name:HALL, SUSANNE MICHELE (PT)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:MICHELE
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 PENNSBURY CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-6716
Mailing Address - Country:US
Mailing Address - Phone:630-817-1127
Mailing Address - Fax:630-372-4595
Practice Address - Street 1:4075 PENNSBURY CT
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-6716
Practice Address - Country:US
Practice Address - Phone:630-817-1127
Practice Address - Fax:630-372-4595
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist