Provider Demographics
NPI:1013228477
Name:WING-DOUGHERTY, SUZANNE K (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:WING-DOUGHERTY
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 1:5930 VANDERVOORT DR STE A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2391
Mailing Address - Country:US
Mailing Address - Phone:402-420-2099
Mailing Address - Fax:402-420-2823
Practice Address - Street 1:5930 VANDERVOORT DR STE A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2391
Practice Address - Country:US
Practice Address - Phone:402-420-2099
Practice Address - Fax:402-420-2823
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077636832Medicaid