Provider Demographics
NPI:1942363759
Name:SUCAET, CAROLYN JOAN (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JOAN
Last Name:SUCAET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2228 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5891
Mailing Address - Country:US
Mailing Address - Phone:586-498-3504
Mailing Address - Fax:586-498-3510
Practice Address - Street 1:20952 12 MILE ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:FM
Practice Address - Zip Code:48091
Practice Address - Country:US
Practice Address - Phone:586-498-3500
Practice Address - Fax:586-498-3510
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist