Provider Demographics
NPI:1023348455
Name:ZUKOSKI, SUZANNE COLEEN
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:COLEEN
Last Name:ZUKOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1466
Mailing Address - Country:US
Mailing Address - Phone:570-575-7641
Mailing Address - Fax:
Practice Address - Street 1:2500 ADAMS AVE
Practice Address - Street 2:HOLY FAMILY RESIDENCE
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1515
Practice Address - Country:US
Practice Address - Phone:570-342-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist