Provider Demographics
NPI:1982836219
Name:GONSALVES, SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GONSALVES
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 1:31 SHOVE ST
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1029
Mailing Address - Country:US
Mailing Address - Phone:401-624-4743
Mailing Address - Fax:401-624-7291
Practice Address - Street 1:31 SHOVE ST
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1029
Practice Address - Country:US
Practice Address - Phone:401-624-4743
Practice Address - Fax:401-624-7291
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist