Provider Demographics
NPI:1649473422
Name:SWEDBERG, SUZANNE BROWN (PT, MHS)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:BROWN
Last Name:SWEDBERG
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 CANOY LANE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631
Mailing Address - Country:US
Mailing Address - Phone:864-654-2001
Mailing Address - Fax:800-305-7112
Practice Address - Street 1:103 CANOY LANE
Practice Address - Street 2:SUITE 113
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631
Practice Address - Country:US
Practice Address - Phone:864-654-2001
Practice Address - Fax:800-305-7112
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ342648772Medicare PIN