MEDICARE: SUZANNE M ROBERTSON P.T., M.S.

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	3966	AZ

General Provider Information

NPI Number	:	1801864244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE M ROBERTSON P.T., M.S.

Provider Business Mailing Address
First Line	:	10240 N CAMINO VALDEFLORES
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85737-3653
Country	:	US
Telephone Number	:	520-270-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	10240 N CAMINO VALDEFLORES
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85737-3653
Country	:	US
Telephone Number	:	520-270-4455
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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