Provider Demographics
NPI:1689908394
Name:GASTON, SUZANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:GASTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MAUS DR
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2057
Mailing Address - Country:US
Mailing Address - Phone:724-863-9118
Mailing Address - Fax:724-863-8334
Practice Address - Street 1:249 MAUS DR
Practice Address - Street 2:
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2057
Practice Address - Country:US
Practice Address - Phone:724-863-9118
Practice Address - Fax:724-863-8334
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000359225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant