Basic Information
| Provider Information | |||||||||
| NPI: | 1902857311 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NESHAT | ||||||||
| FirstName: | SUZANNE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 N EL CAMINO REAL | ||||||||
| Address2: | #210 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606340248 | ||||||||
| FaxNumber: | 7606341782 | ||||||||
| Practice Location | |||||||||
| Address1: | 4060 4TH AVE | ||||||||
| Address2: | #105 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192995246 | ||||||||
| FaxNumber: | 6192995751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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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 | PT 15992 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | WPT15992E | 01 | CA | MEDICARE PTAN | OTHER |