Provider Demographics
NPI:1285831263
Name:SUITTS, MARK (LPTA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SUITTS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3286 COUNTY HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-2900
Mailing Address - Country:US
Mailing Address - Phone:205-486-9478
Mailing Address - Fax:
Practice Address - Street 1:2201 11TH AVE
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1613
Practice Address - Country:US
Practice Address - Phone:205-486-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA784225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant