Provider Demographics
NPI:1851434047
Name:SUITER, GINA VICTORIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:VICTORIA
Last Name:SUITER
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 1:1195 CLARKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42286-9763
Mailing Address - Country:US
Mailing Address - Phone:931-552-3002
Mailing Address - Fax:931-647-8246
Practice Address - Street 1:2134 OLD ASHLAND CITY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4972
Practice Address - Country:US
Practice Address - Phone:931-552-3002
Practice Address - Fax:931-647-8246
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5227OtherSTATE LICENSE