Provider Demographics
NPI:1700085495
Name:STRONG, SUZANNE MARIE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:MARIE
Last Name:STRONG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15322 ROYAL TROON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6128
Mailing Address - Country:US
Mailing Address - Phone:502-333-2087
Mailing Address - Fax:
Practice Address - Street 1:3510 GOLDSMITH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2314
Practice Address - Country:US
Practice Address - Phone:502-333-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT9902255A2300X
TN11272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer