Provider Demographics
NPI:1538407283
Name:WILLIAMS, SUSAN BORCK (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BORCK
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BORCK-WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:443 SAINT THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4471
Mailing Address - Country:US
Mailing Address - Phone:513-675-0332
Mailing Address - Fax:
Practice Address - Street 1:443 SAINT THOMAS CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4471
Practice Address - Country:US
Practice Address - Phone:513-675-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-03647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist