Provider Demographics
NPI:1790910156
Name:ELDER, SUZANNE P (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:P
Last Name:ELDER
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 1:266 JOULE ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2422
Mailing Address - Country:US
Mailing Address - Phone:865-268-2377
Mailing Address - Fax:865-380-1785
Practice Address - Street 1:266 JOULE ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2422
Practice Address - Country:US
Practice Address - Phone:865-268-2377
Practice Address - Fax:865-380-1785
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36460252Medicare PIN
TN0677340001Medicare NSC
3646025Medicare PIN
36460251Medicare PIN
TN103I651877Medicare PIN
TN0677340003Medicare NSC