Basic Information
| Provider Information | |||||||||
| NPI: | 1598208258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUCKOW | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 DRY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805036405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204944750 | ||||||||
| FaxNumber: | 7204944751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 DRY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204944750 | ||||||||
| FaxNumber: | 7204944751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2016 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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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 | 0014272 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.