Provider Demographics
NPI:1689779225
Name:DUNKLE, SUZANNE V (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:V
Last Name:DUNKLE
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 1:4595 TOWNE LAKE PKWY # 300/240
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5514
Mailing Address - Country:US
Mailing Address - Phone:770-592-3386
Mailing Address - Fax:770-592-3387
Practice Address - Street 1:4595 TOWNE LAKE PKWY # 300/240
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:770-592-3386
Practice Address - Fax:770-592-3387
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q44248Medicare UPIN
GA65BBCZFMedicare PIN