Healthcare Provider Details

I. General information

NPI: 1689011215
Provider Name (Legal Business Name): VINCENT M SUAZO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S CAMINO DEL PUEBLO
BERNALILLO NM
87004-6076
US

IV. Provider business mailing address

7849 TRAMWAY BLVD NE STE A
ALBUQUERQUE NM
87122-2529
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-2836
  • Fax: 505-212-6746
Mailing address:
  • Phone: 54-854-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2025-0108
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: