Provider Demographics
NPI:1740368794
Name:MORTON-MILLER, SUZANNE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:MORTON-MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1715
Mailing Address - Country:US
Mailing Address - Phone:515-993-3517
Mailing Address - Fax:515-993-5473
Practice Address - Street 1:1205 GREENE ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1715
Practice Address - Country:US
Practice Address - Phone:515-993-3517
Practice Address - Fax:515-993-5473
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10851OtherBLUE CROSS