Provider Demographics
NPI:1669638524
Name:KASIRYE, SUUBI ALEXANDRA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:SUUBI
Middle Name:ALEXANDRA
Last Name:KASIRYE
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 1:411 MASS AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3739
Mailing Address - Country:US
Mailing Address - Phone:978-263-0007
Mailing Address - Fax:978-263-0014
Practice Address - Street 1:411 MASS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3739
Practice Address - Country:US
Practice Address - Phone:978-263-0007
Practice Address - Fax:978-263-0014
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist