Provider Demographics
NPI:1538619945
Name:WEISS, SUSAN COLLINS (MPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:COLLINS
Last Name:WEISS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:G
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:850 43RD AVE STE 300
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8401
Practice Address - Country:US
Practice Address - Phone:309-743-0300
Practice Address - Fax:309-743-0318
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082447225100000X
IL070-013331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist