Provider Demographics
NPI:1083640031
Name:THOMPSON, SUZANNE KATHLEEN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KATHLEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W BROWN RD
Mailing Address - Street 2:UNIT 30
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3422
Mailing Address - Country:US
Mailing Address - Phone:602-510-7908
Mailing Address - Fax:480-361-1174
Practice Address - Street 1:222 W BROWN RD
Practice Address - Street 2:UNIT 30
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3422
Practice Address - Country:US
Practice Address - Phone:602-510-7908
Practice Address - Fax:480-361-1174
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist