Provider Demographics
NPI:1003099649
Name:GRACE, SUZANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-558-4491
Mailing Address - Fax:865-558-4493
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4491
Practice Address - Fax:865-558-4493
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5564225100000X
SC5233225100000X
NC10851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00747042OtherRAILROAD MEDICARE
TN4223417OtherBLUECROSS BLUESHIELD
TN1512782Medicaid
TN1512782Medicaid