Provider Demographics
NPI:1518270941
Name:VANDERKOOI, SUZANNE (DPT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:VANDERKOOI
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:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1130
Mailing Address - Country:US
Mailing Address - Phone:928-298-5528
Mailing Address - Fax:928-441-8421
Practice Address - Street 1:3623 CROSSINGS DR STE 282
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7101
Practice Address - Country:US
Practice Address - Phone:928-296-9285
Practice Address - Fax:928-441-8421
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11384-024225100000X
MO2022020625225100000X
AZCP026174T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist