Provider Demographics
NPI:1033707005
Name:SUAREZ-MANJARRES, MARIO (DPT)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:SUAREZ-MANJARRES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 155A
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1566
Practice Address - Country:US
Practice Address - Phone:248-479-6330
Practice Address - Fax:248-479-6331
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist