Provider Demographics
NPI:1558403774
Name:MCKENNA, SUZANNE E (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:E
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:E
Other - Last Name:HOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2279 JEANETTE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-4700
Mailing Address - Country:US
Mailing Address - Phone:719-638-8105
Mailing Address - Fax:719-636-3772
Practice Address - Street 1:325 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3134
Practice Address - Country:US
Practice Address - Phone:719-630-8000
Practice Address - Fax:719-636-3772
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist