Provider Demographics
NPI:1548433923
Name:COOL, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:COOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 MALL DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7634
Mailing Address - Country:US
Mailing Address - Phone:715-552-1036
Mailing Address - Fax:
Practice Address - Street 1:3656 MALL DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7634
Practice Address - Country:US
Practice Address - Phone:715-552-1036
Practice Address - Fax:715-552-4567
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390848401050OtherBLUE CROSS
WI11014100Medicaid
WI11014110Medicaid
WI2081-24OtherLICENSE NUMBER
WI11014110Medicaid
WI390848401050OtherBLUE CROSS
WI52Z310Medicare Oscar/Certification