MEDICARE: SUZANNA K SLISKI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6697	CO

General Provider Information

NPI Number	:	1235210790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA K SLISKI PT

Provider Business Mailing Address
First Line	:	1106 E PROSPECT RD STE 200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5304
Country	:	US
Telephone Number	:	970-495-8454
Fax Number	:	970-495-8495

Provider Business Practice Location Address
First Line	:	1106 E PROSPECT RD STE 200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5304
Country	:	US
Telephone Number	:	970-495-8454
Fax Number	:	970-495-8495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/01/2020

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