Provider Demographics
NPI:1659002590
Name:SUZUKI, EIKO (DPT)
Entity Type:Individual
Prefix:
First Name:EIKO
Middle Name:
Last Name:SUZUKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EIKO
Other - Middle Name:
Other - Last Name:SILLITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:562 E 2200 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6235
Mailing Address - Country:US
Mailing Address - Phone:832-229-7005
Mailing Address - Fax:
Practice Address - Street 1:562 E 2200 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6235
Practice Address - Country:US
Practice Address - Phone:832-229-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12813166-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist