Provider Demographics
NPI:1184632952
Name:DEVITTO, SUZANNE ELAINE (PT CEES)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELAINE
Last Name:DEVITTO
Suffix:
Gender:F
Credentials:PT CEES
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:ELAINE
Other - Last Name:AMENDARIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1000 E MAIN ST
Mailing Address - Street 2:SUITE #303
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065
Mailing Address - Country:US
Mailing Address - Phone:972-723-5005
Mailing Address - Fax:972-723-5008
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:SUITE #303
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:972-723-5005
Practice Address - Fax:972-723-5008
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
803022Medicare ID - Type Unspecified