Provider Demographics
NPI:1245656149
Name:CORZINE, SUZANNE (PTA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CORZINE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15051 GREEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8547
Mailing Address - Country:US
Mailing Address - Phone:352-988-9476
Mailing Address - Fax:
Practice Address - Street 1:405 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5520
Practice Address - Country:US
Practice Address - Phone:352-394-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL155072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics