Provider Demographics
NPI:1801864244
Name:ROBERTSON, SUZANNE M (PT, MS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10240 N CAMINO VALDEFLORES
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-3653
Mailing Address - Country:US
Mailing Address - Phone:520-270-4455
Mailing Address - Fax:
Practice Address - Street 1:10240 N CAMINO VALDEFLORES
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-3653
Practice Address - Country:US
Practice Address - Phone:520-270-4455
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist