Provider Demographics
NPI:1003550666
Name:TEEUWEN, SUSANNAH (PTA)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:TEEUWEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W COUNTY LINE RD APT 31-204
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6510
Mailing Address - Country:US
Mailing Address - Phone:205-789-2936
Mailing Address - Fax:
Practice Address - Street 1:600 W COUNTY LINE RD APT 31-204
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-6510
Practice Address - Country:US
Practice Address - Phone:205-789-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014830225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant