Provider Demographics
NPI:1962968826
Name:COUNTRYMAN, SUZANNE KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KATHLEEN
Last Name:COUNTRYMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 POSSUM HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7239
Mailing Address - Country:US
Mailing Address - Phone:917-716-6733
Mailing Address - Fax:
Practice Address - Street 1:2951 HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:GEORGE WEST
Practice Address - State:TX
Practice Address - Zip Code:78022-3845
Practice Address - Country:US
Practice Address - Phone:800-456-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01170300225100000X
TX1102721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist