Basic Information
| Provider Information | |||||||||
| NPI: | 1205190881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONAHUE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 ALMAC DR | ||||||||
| Address2: | |||||||||
| City: | PROCTOR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558102723 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 W SUPERIOR ST | ||||||||
| Address2: | STE 112 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558061856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187271180 | ||||||||
| FaxNumber: | 2187271461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 06/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 7340 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.