Provider Demographics
NPI:1679789853
Name:BARNHART, SUZANNE S (LPT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:S
Last Name:BARNHART
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2531
Mailing Address - Country:US
Mailing Address - Phone:330-875-6108
Mailing Address - Fax:330-875-6108
Practice Address - Street 1:4181 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2531
Practice Address - Country:US
Practice Address - Phone:330-875-6108
Practice Address - Fax:330-875-6108
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-001327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000164934OtherANTHEM
OH0279489Medicaid