Provider Demographics
NPI:1659436178
Name:PRYBELL, SUZANNE M (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:PRYBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:OSULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:605 S EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-6507
Mailing Address - Country:US
Mailing Address - Phone:815-671-4215
Mailing Address - Fax:
Practice Address - Street 1:605 S EDWARD DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6507
Practice Address - Country:US
Practice Address - Phone:815-671-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00863072OtherMEDICARE RR
IL216860007Medicare PIN
ILIL3585007Medicare PIN
IL202845199Medicare PIN
ILK35595Medicare PIN