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General NPI Number Information
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NPI Number | 1205139433
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Entity Type | Individual
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Provider Name | SUZANNA LU DAILEY P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 1110 W 11TH ST
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City | CONCORDIA
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State | KS
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Zip | 66901-3902
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Country | US
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Telephone | 785-243-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 427 W 18TH ST
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City | CONCORDIA
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State | KS
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Zip | 66901-4117
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Country | US
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Telephone | 785-243-6318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-00706
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License Number State | KS
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