Provider Demographics
NPI:1689959074
Name:LEGG-MATTHEWS, SUZANNE (RPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LEGG-MATTHEWS
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 1:6782 S LEYDEN CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1005
Mailing Address - Country:US
Mailing Address - Phone:720-528-1582
Mailing Address - Fax:
Practice Address - Street 1:2525 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3273
Practice Address - Country:US
Practice Address - Phone:720-962-4555
Practice Address - Fax:720-962-4466
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist