Provider Demographics
NPI:1346451739
Name:JACKSON, SUZANNE SAMMONS (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:SAMMONS
Last Name:JACKSON
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 1:2579 JARDIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327
Mailing Address - Country:US
Mailing Address - Phone:954-594-0299
Mailing Address - Fax:
Practice Address - Street 1:5856 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3238
Practice Address - Country:US
Practice Address - Phone:954-252-6014
Practice Address - Fax:954-252-6015
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT62062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic