Provider Demographics
NPI:1902969678
Name:MADSON, SUZETTE FLORENCE (PT)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:FLORENCE
Last Name:MADSON
Suffix:
Gender:F
Credentials:PT
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 6175
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-0175
Mailing Address - Country:US
Mailing Address - Phone:425-643-0373
Mailing Address - Fax:425-747-6367
Practice Address - Street 1:634 7TH AVE OFC 6
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5665
Practice Address - Country:US
Practice Address - Phone:425-542-3306
Practice Address - Fax:425-747-6367
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025208 PT00006112225100000X, 2251S0007X, 2251X0800X
NY032698225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA112243OtherLABOR AND INDUSTRIES
WAMA0471OtherREGENCE BLUE SHIELD