Provider Demographics
NPI:1700582541
Name:SUEZO, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SUEZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSEPH D
Other - Middle Name:
Other - Last Name:SUEZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:365 GRACELAND AVE UNIT 204
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-7880
Mailing Address - Country:US
Mailing Address - Phone:773-231-3963
Mailing Address - Fax:
Practice Address - Street 1:1601 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1233
Practice Address - Country:US
Practice Address - Phone:847-825-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist