Healthcare Provider Details

I. General information

NPI: 1396878963
Provider Name (Legal Business Name): TRINA M RADSKE-SUCHAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 DOUGLAS AVE
URBANDALE IA
50322
US

IV. Provider business mailing address

6601 WESTOWN PKWY STE 1020
WEST DES MOINES IA
50266-7731
US

V. Phone/Fax

Practice location:
  • Phone: 515-251-3700
  • Fax: 515-251-3733
Mailing address:
  • Phone: 515-512-9225
  • Fax: 515-512-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03381
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: