Provider Demographics
NPI:1326256439
Name:TESKE, SUZY MARIE DUPONT (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZY
Middle Name:MARIE DUPONT
Last Name:TESKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 FIRESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2037
Mailing Address - Country:US
Mailing Address - Phone:319-268-9030
Mailing Address - Fax:319-268-9030
Practice Address - Street 1:515 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2500
Practice Address - Country:US
Practice Address - Phone:319-268-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist