Provider Demographics
NPI:1598893083
Name:SUITER, LYNNETTE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:MARIE
Last Name:SUITER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13737 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-8624
Mailing Address - Country:US
Mailing Address - Phone:573-483-2606
Mailing Address - Fax:
Practice Address - Street 1:13737 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-8624
Practice Address - Country:US
Practice Address - Phone:573-483-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist