Susan Bolden

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2017158 Issued in TX

Practice address

206 Maryland Ave
McComb, MS 39648-3926

Phone

(601) 250-4815

Fax

(601) 250-6859

NPI assigned

May 22, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1154530541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 LINDEN AVE",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718543859",
            "telephone_number": "601-250-4815",
            "fax_number": "601-250-6859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MARYLAND AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483926",
            "telephone_number": "601-250-4815",
            "fax_number": "601-250-6859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDEN",
        "first_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "999",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2017158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyla Bland
• Blessed Haven Independent Living LLC
• Wendy Haydel Blue, P.T. PHARM D.
• Gary Bronson Bubba Boggs, AGACNP
• Gevoni Bolden, PHARMD
• Barbara Bond, MD
• Robin Bonds, DPT
• Daniel Boone, DO
• Sonjia Mechelle Boone, RDN, LD
• James Boothe, M. D.

• All providers in McComb, MS
• Physical Therapy Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.