Provider Demographics
NPI:1720372378
Name:DAVIS, SUZANNE E (LPTA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 STOBHILL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7248
Mailing Address - Country:US
Mailing Address - Phone:919-610-6750
Mailing Address - Fax:
Practice Address - Street 1:750 SE CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5682
Practice Address - Country:US
Practice Address - Phone:919-460-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant