Provider Demographics
NPI:1386808087
Name:SUVER, MARY JO I (PTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:SUVER
Suffix:I
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:SUVER
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:422 MILWAUKEE BLVD S
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047-1315
Mailing Address - Country:US
Mailing Address - Phone:253-833-2479
Mailing Address - Fax:
Practice Address - Street 1:1010 S 336TH ST
Practice Address - Street 2:STE#210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6385
Practice Address - Country:US
Practice Address - Phone:253-835-8091
Practice Address - Fax:253-835-7102
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant