Basic Information
| Provider Information | |||||||||
| NPI: | 1396878963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADSKE-SUCHAN | ||||||||
| FirstName: | TRINA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6601 WESTOWN PKWY STE 1020 | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502667731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155129225 | ||||||||
| FaxNumber: | 5155129186 | ||||||||
| Practice Location | |||||||||
| Address1: | 7011 DOUGLAS AVE | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152513700 | ||||||||
| FaxNumber: | 5152513733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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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 | 225100000X | 03381 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.