Kimberlee Dae Susi, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PA6572 Issued in ME

Practice address

163 Van Buren Rd Ste 1
Caribou, ME 04736-3588

Phone

(207) 498-1170

NPI assigned

Jul 14, 2023

Last updated

Jul 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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": "1689292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1821777012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 SWEDEN ST UNIT 2",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "047362101",
            "telephone_number": "207-551-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 VAN BUREN RD STE 1",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "047363588",
            "telephone_number": "207-498-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSI",
        "first_name": "KIMBERLEE",
        "middle_name": "DAE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ME",
            "license": "PA6572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Marie St Peter, PT, DPT
• Kristi Marie St. Peter, OTR/L
• Lisa St. Peter, P.T.
• Danielle J. C. Stairs, MSOTR/L
• Emily R Steinhauer, CTRS
• Caleb Swanberg, MD
• Anne Swanson
• Marilyn Baclor Tamayo, PT
• Shane Edward Theriault, LSW-C
• Meagan May Thompson, DMD

• Physical Therapy Assistant in Caribou, ME
• Providers in Caribou, ME by specialty
• Physical Therapy Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; 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.