Provider Demographics
NPI:1528190683
Name:SUAZO, MA ANELYN CARBONILLA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MA ANELYN
Middle Name:CARBONILLA
Last Name:SUAZO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4926
Mailing Address - Country:US
Mailing Address - Phone:845-567-1787
Mailing Address - Fax:
Practice Address - Street 1:2720 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4926
Practice Address - Country:US
Practice Address - Phone:845-567-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013814-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist