Provider Demographics
NPI:1114092095
Name:ZELASKO, SUZANNE J (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:J
Last Name:ZELASKO
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 1:2940 SYCKELMOORE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3527
Mailing Address - Country:US
Mailing Address - Phone:734-676-2999
Mailing Address - Fax:
Practice Address - Street 1:3200 BIDDLE ST FL 3
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5937
Practice Address - Country:US
Practice Address - Phone:743-324-3963
Practice Address - Fax:734-324-3918
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist