Provider Demographics
NPI:1487758637
Name:CRITCHLEY, SUZANNE ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:CRITCHLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:E
Other - Last Name:CRITCHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 711185
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171
Mailing Address - Country:US
Mailing Address - Phone:801-942-3311
Mailing Address - Fax:801-943-3989
Practice Address - Street 1:1952 EAST 7000 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-942-3311
Practice Address - Fax:801-943-3989
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52682802401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4886Medicaid