MEDICARE: SUZANNE SILVA

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	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2042380	OTHER	TX	LICENSE#

General Provider Information

NPI Number	:	1659481372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE SILVA

Provider Business Mailing Address
First Line	:	1624 SHADYOAK DR
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-9346
Country	:	US
Telephone Number	:	979-618-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4945 SWEETWATER BLVD
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3133
Country	:	US
Telephone Number	:	281-277-1330
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ SUZANNE SILVA ” Practice Location

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