Provider Demographics
NPI:1073623567
Name:SUSKI, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SUSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 E KIVA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2440
Mailing Address - Country:US
Mailing Address - Phone:480-354-6138
Mailing Address - Fax:
Practice Address - Street 1:2853 S SOSSAMAN RD
Practice Address - Street 2:STE A106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9625
Practice Address - Country:US
Practice Address - Phone:480-373-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6496OtherLICENSE #