Provider Demographics
NPI:1316588593
Name:BRUCE, SUZANNE MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MICHELE
Other - Last Name:KASSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:3263 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1618
Mailing Address - Country:US
Mailing Address - Phone:314-771-0862
Mailing Address - Fax:
Practice Address - Street 1:15201 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1810
Practice Address - Country:US
Practice Address - Phone:636-532-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist