Provider Demographics
NPI:1467900886
Name:MCCRUM, SUZANNE (MS,PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MCCRUM
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MCCRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:31620 MEADOW CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 E BANDERA RD STE 2
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2992
Practice Address - Country:US
Practice Address - Phone:830-331-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist