Healthcare Provider Details

I. General information

NPI: 1225461858
Provider Name (Legal Business Name): KATHLEEN SHERYL SUWANSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S CHESTER AVE UNIT 1
PASADENA CA
91106-3143
US

IV. Provider business mailing address

212 S CHESTER AVE UNIT 1
PASADENA CA
91106-3143
US

V. Phone/Fax

Practice location:
  • Phone: 847-877-8503
  • Fax:
Mailing address:
  • Phone: 847-877-8503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40412
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: