Provider Demographics
NPI:1578893046
Name:COLEMAN, SUZANNE (MSPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:CITRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8528 BERMONDSEY MARKET WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4887
Mailing Address - Country:US
Mailing Address - Phone:919-761-9935
Mailing Address - Fax:
Practice Address - Street 1:280 S BECKFORD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2564
Practice Address - Country:US
Practice Address - Phone:252-438-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist