Provider Demographics
NPI:1093391559
Name:VENTURA, SUZANNE (PTA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:VENTURA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WRENCREST CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6324
Mailing Address - Country:US
Mailing Address - Phone:813-777-6216
Mailing Address - Fax:
Practice Address - Street 1:2611 WRENCREST CIR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6324
Practice Address - Country:US
Practice Address - Phone:813-777-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant