Provider Demographics
NPI:1215979224
Name:DANIEL, DIANNE RENE SUZOR (PT, MS)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:RENE SUZOR
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:YELLOW JACKET
Mailing Address - State:CO
Mailing Address - Zip Code:81335-0304
Mailing Address - Country:US
Mailing Address - Phone:970-562-4812
Mailing Address - Fax:
Practice Address - Street 1:14524 ROAD W
Practice Address - Street 2:
Practice Address - City:YELLOW JACKET
Practice Address - State:CO
Practice Address - Zip Code:81335-5041
Practice Address - Country:US
Practice Address - Phone:970-562-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist