Provider Demographics
NPI:1326502675
Name:TEZANOS, SUZANNE DEEGAN (DPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DEEGAN
Last Name:TEZANOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:ELIZABETH
Other - Last Name:DEEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6024 COSTEN LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3134
Mailing Address - Country:US
Mailing Address - Phone:817-247-8159
Mailing Address - Fax:
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2122
Practice Address - Country:US
Practice Address - Phone:817-250-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1275645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist