Basic Information
| Provider Information | |||||||||
| NPI: | 1801855267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADSEN-KOSTOPOULOS | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| OtherLastName: | MADSEN | ||||||||
| OtherFirstName: | SUZANNE | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254552630 | ||||||||
| FaxNumber: | 4254514390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 10/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00008033 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.