Provider Demographics
NPI:1558349571
Name:LEE, SUZANNA S (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNA
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:MSPT
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:8266 ATLEE RD
Practice Address - Street 2:SUITE 133PT
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1804
Practice Address - Country:US
Practice Address - Phone:804-569-1665
Practice Address - Fax:804-569-1628
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070010739225100000X
VA2305202407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558349571Medicaid
VA1558349571Medicaid
VA0472640012Medicare NSC