Provider Demographics
NPI:1124108071
Name:SEALEY, SUZANNE ADELE (MPT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ADELE
Last Name:SEALEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5515
Mailing Address - Country:US
Mailing Address - Phone:805-934-0543
Mailing Address - Fax:
Practice Address - Street 1:880 OAK PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1821
Practice Address - Country:US
Practice Address - Phone:805-473-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist