Provider Demographics
NPI:1073691291
Name:SADUSKY, SUZANNE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:SADUSKY
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 1:1915 RANDOLPH RD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1101
Mailing Address - Country:US
Mailing Address - Phone:704-339-1224
Mailing Address - Fax:704-339-1444
Practice Address - Street 1:16455 STATESVILLE RD STE 102
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7137
Practice Address - Country:US
Practice Address - Phone:704-323-2809
Practice Address - Fax:704-339-1444
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic