Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2744 | AZ |
NPI | 1134277262 |
---|---|
Provider Name | Ms. Suzanne Lynn Kessner |
First Address | Phoenix, AZ 85054-6108 |
Second Address | Scottsdale, AZ 85254-4600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
197279 | (05) | AZ |