Provider Demographics
NPI:1205190881
Name:DONAHUE, SUZANNE ELIZABETH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1108 ALMAC DR
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:MN
Mailing Address - Zip Code:55810-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 W SUPERIOR ST
Practice Address - Street 2:STE 112
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1856
Practice Address - Country:US
Practice Address - Phone:218-727-1180
Practice Address - Fax:218-727-1461
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics