Provider Demographics
NPI:1922499383
Name:BAYSA, SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BAYSA
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 1:1952 E FORT UNION BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6877
Mailing Address - Country:US
Mailing Address - Phone:801-456-8409
Mailing Address - Fax:801-495-5302
Practice Address - Street 1:2670 PACIFIC HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-1049
Practice Address - Country:US
Practice Address - Phone:808-524-1955
Practice Address - Fax:808-537-5418
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT -3179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist