Provider Demographics
NPI:1538721089
Name:SALIBA, SUSAN A (PT, ATC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SALIBA
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400407
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22904-4407
Mailing Address - Country:US
Mailing Address - Phone:434-243-4033
Mailing Address - Fax:434-924-1389
Practice Address - Street 1:210 EMMET ST S
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2455
Practice Address - Country:US
Practice Address - Phone:434-243-4033
Practice Address - Fax:434-924-1389
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260004422255A2300X
VA23050036632251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer