Provider Demographics
NPI:1114001484
Name:KNOX, SUZANNE (PT, CSCS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KNOX
Suffix:
Gender:F
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NW GREENWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1550
Mailing Address - Country:US
Mailing Address - Phone:541-923-0410
Mailing Address - Fax:541-923-7393
Practice Address - Street 1:450 NW GREENWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1550
Practice Address - Country:US
Practice Address - Phone:541-923-0410
Practice Address - Fax:541-923-7393
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ286803OtherPACIFICSOURCE
OR0147433OtherUS DEPT L&I
OR230556Medicaid
OR230556Medicaid