Basic Information
| Provider Information | |||||||||
| NPI: | 1518229004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUITER | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451331231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377631604 | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | BLANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451071310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377834949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 06/12/2012 | ||||||||
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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 | 225200000X | PTA.07968 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.