Provider Demographics
NPI:1689011215
Name:SUAZO, VINCENT M (PT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:SUAZO
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 TRAMWAY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2529
Mailing Address - Country:US
Mailing Address - Phone:054-854-1765
Mailing Address - Fax:
Practice Address - Street 1:240 S CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6076
Practice Address - Country:US
Practice Address - Phone:505-373-2836
Practice Address - Fax:505-212-6746
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist