Provider Demographics
NPI:1164011300
Name:SUCKIEL, KRISTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SUCKIEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:408 CHRIS GAUPP DR STE 200
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4491
Practice Address - Country:US
Practice Address - Phone:609-652-3774
Practice Address - Fax:609-652-3776
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028877225100000X
NJ40QA01924100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist