Provider Demographics
NPI:1104958396
Name:ENOS, SUZANNE D (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:D
Last Name:ENOS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 STONY RIDGE RD
Mailing Address - Street 2:#22
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-7336
Mailing Address - Country:US
Mailing Address - Phone:502-299-4775
Mailing Address - Fax:
Practice Address - Street 1:2001 NEWBURG RD
Practice Address - Street 2:KNIGHTS HALL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1863
Practice Address - Country:US
Practice Address - Phone:502-452-8379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT4532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY22OtherRESPIRATORY, REHABILITATI