Provider Demographics
NPI:1609334457
Name:TEUBEN, SUZANNE NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:TEUBEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 KING RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8809
Mailing Address - Country:US
Mailing Address - Phone:916-652-5700
Mailing Address - Fax:916-652-5708
Practice Address - Street 1:6125 KING RD STE 102
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8809
Practice Address - Country:US
Practice Address - Phone:916-652-5700
Practice Address - Fax:916-652-5708
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist