Provider Demographics
NPI:1790845766
Name:BUELL, SUZANNE BEA (MS,PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BEA
Last Name:BUELL
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E PIONEER
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3267
Mailing Address - Country:US
Mailing Address - Phone:253-604-4824
Mailing Address - Fax:253-604-4826
Practice Address - Street 1:417 E PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3267
Practice Address - Country:US
Practice Address - Phone:253-604-4824
Practice Address - Fax:253-604-4826
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121403Medicaid
WA8801800Medicare PIN
WA7121403Medicaid