=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285773028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE DJ PASQUINI P.T, MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 MAGNOLIA SQ
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24450-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-463-3490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 VALLEY VIEW LN
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24435-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-348-5252
-----------------------------------------------------
Fax | 540-348-5252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2305204005
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------