MEDICARE: SUZANNE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2117	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265575930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE INC

Provider Business Mailing Address
First Line	:	310 W 11TH ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5113
Country	:	US
Telephone Number	:	575-534-1187
Fax Number	:	575-534-1439

Provider Business Practice Location Address
First Line	:	310 W 11TH ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5113
Country	:	US
Telephone Number	:	575-534-1187
Fax Number	:	575-534-1439

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SUZANNE NMI THOMAS
Credential	:	MPT
Telephone Number	:	505-534-1187

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	05/07/2008

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Directions to “SUZANNE INC ” Practice Location

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