Provider Demographics
NPI:1083993653
Name:SUAREZ, NANCY KRISTENSEN (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KRISTENSEN
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4061
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05406-4061
Mailing Address - Country:US
Mailing Address - Phone:802-863-6662
Mailing Address - Fax:802-861-2224
Practice Address - Street 1:1 KENNEDY DR
Practice Address - Street 2:SUITE L-2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7152
Practice Address - Country:US
Practice Address - Phone:802-863-6662
Practice Address - Fax:802-861-2224
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0002800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist