Provider Demographics
NPI:1578560975
Name:MATSUMOTO, SUZANNE M (MPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:MATSUMOTO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28648 N 108TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-4648
Mailing Address - Country:US
Mailing Address - Phone:602-617-4014
Mailing Address - Fax:
Practice Address - Street 1:28648 N 108TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-4648
Practice Address - Country:US
Practice Address - Phone:602-617-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP62181Medicare UPIN
AZ83142Medicare ID - Type Unspecified