Active NPI
Susan B Ham
- Physical Therapist
- Waltham, MA
National Provider Identifier
1477761294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11330
- Practice address
- 85 1St Ave
Waltham, MA 02451-1105 - Phone
- (781) 895-7900
- Fax
- (781) 290-0720
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11330 | MA | Primary |
Addresses
Primary practice location
85 1St Ave
Waltham, MA 02451-1105
Mailing address
85 1St Ave
Waltham, MA 02451-1105
Phone (781) 895-7900
Other names 1
- Susan Bourgeois
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477761294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 1ST AVE",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511105",
"telephone_number": "781-895-7900",
"fax_number": "781-290-0720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 1ST AVE",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511105",
"telephone_number": "781-895-7900",
"fax_number": "781-290-0720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAM",
"first_name": "SUSAN",
"middle_name": "B",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "11330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "BOURGEOIS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.