Provider Demographics
NPI:1932381373
Name:SUSZCZYNSKA, SELENA RENATA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:RENATA
Last Name:SUSZCZYNSKA
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 1:429 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7613
Mailing Address - Country:US
Mailing Address - Phone:931-433-3929
Mailing Address - Fax:
Practice Address - Street 1:501 AMANA AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3365
Practice Address - Country:US
Practice Address - Phone:931-433-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist