Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT#618 | ME |
N | 2251E1200X | Ergonomics | PT#618 | ME |
N | 225XE1200X | Ergonomics | PT#618 | ME |
N | 2251G0304X | Physical Therapist - Geriatrics | PT#618 | ME |
N | 2251N0400X | Physical Therapist - Neurology | PT#618 | ME |
N | 2251P0200X | Physical Therapist - Pediatrics | PT#618 | ME |
N | 2251X0800X | Physical Therapist - Orthopedic | PT#618 | ME |
NPI | 1124095419 |
---|---|
Provider Name | Ms. Susan Ruth Lifer |
First Address | Lincoln, ME 04457-1167 |
Second Address | Lincoln, ME 04457-1167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024694 | ANTHEM BC/BS (01) | ME |
5312641 | AETNA PROVIDER ID (01) | ME |