Provider Demographics
NPI:1225364094
Name:GUBBELS, SUZANNE KAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KAY
Last Name:GUBBELS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1941
Mailing Address - Country:US
Mailing Address - Phone:402-833-5343
Mailing Address - Fax:402-833-5349
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1941
Practice Address - Country:US
Practice Address - Phone:402-833-5343
Practice Address - Fax:402-833-5349
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE909225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant