Healthcare Provider Details

I. General information

NPI: 1588822621
Provider Name (Legal Business Name): ANDREA MARIE SUCHARDA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MARIE CLORE

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

IV. Provider business mailing address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

V. Phone/Fax

Practice location:
  • Phone: 414-647-7422
  • Fax:
Mailing address:
  • Phone: 414-647-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9671-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: