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NPI Code Detail

MEDICARE: RICHARD KENNETH SUAREZ JR. LPTA

MEDICARE: RICHARD KENNETH SUAREZ JR. LPTA
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1689156952
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD KENNETH SUAREZ JR. LPTA
Provider Business Mailing Address
First Line : 600 BREEZE PARK DR
Second Line :
City : WELDON SPRING
State : MO
Zip : 63304-9139
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 BREEZE PARK DR
Second Line :
City : WELDON SPRING
State : MO
Zip : 63304-9139
Country : US
Telephone Number : 636-939-5223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 09/04/2018

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