Provider Demographics
NPI:1629353149
Name:SUAREZ, VICKI (PT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:SUAREZ
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 1:6514 FLYCATCHER LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8268
Mailing Address - Country:US
Mailing Address - Phone:941-350-5757
Mailing Address - Fax:
Practice Address - Street 1:6514 FLYCATCHER LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8268
Practice Address - Country:US
Practice Address - Phone:941-350-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist