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Individual

DR. SUSANNA (SUNEL) P VAN DER WALT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
5700 HARPER DR NE STE 250, ALBUQUERQUE, NM 87109-3588
(505) 828-2273
Mailing address
30 ANASAZI TRAILS LOOP, PLACITAS, NM 87043-8760
(505) 639-9937

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
4594
NM
2251X0800X
Orthopedic Physical Therapist
4594
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10171568
NM
01
326556
MEDICARE
NM
Enumeration date
02/23/2015
Last updated
01/01/2021
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