Provider Demographics
NPI:1750591624
Name:PATENAUDE, SUZANNE S (PT, MA CIE)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:PATENAUDE
Suffix:
Gender:F
Credentials:PT, MA CIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 VINEYARD TOWN CTR
Mailing Address - Street 2:#354
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5674
Mailing Address - Country:US
Mailing Address - Phone:408-690-5654
Mailing Address - Fax:831-630-1717
Practice Address - Street 1:305 VINEYARD TOWN CTR
Practice Address - Street 2:#354
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5674
Practice Address - Country:US
Practice Address - Phone:408-690-5654
Practice Address - Fax:831-630-1717
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2573173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QP200XOtherPHYSICAL THERAPY