Provider Demographics
NPI:1902969678
Name:MADSON, SUZETTE FLORENCE (PT)
Entity Type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:FLORENCE
Last Name:MADSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6175
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-0175
Mailing Address - Country:US
Mailing Address - Phone:425-643-0373
Mailing Address - Fax:425-747-6367
Practice Address - Street 1:15921 NE 8TH ST
Practice Address - Street 2:SUITE C204
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3923
Practice Address - Country:US
Practice Address - Phone:425-643-0373
Practice Address - Fax:425-747-6367
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025208 PT00006112225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA0471OtherREGENCE BLUE SHIELD
WA112243OtherLABOR AND INDUSTRIES