Provider Demographics
NPI:1659876217
Name:WILLIAMS, SUZANNE (RPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16760 ORANGE LN
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-9209
Mailing Address - Country:US
Mailing Address - Phone:860-205-4334
Mailing Address - Fax:
Practice Address - Street 1:HOLLY HILL NURSING HOME
Practice Address - Street 2:10190 FAIRMOUNT RD
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065
Practice Address - Country:US
Practice Address - Phone:440-564-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist