Healthcare Provider Details

I. General information

NPI: 1649603226
Provider Name (Legal Business Name): JAMIE SU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WALL ST
NEW YORK NY
10005-2201
US

IV. Provider business mailing address

30 WALL ST
NEW YORK NY
10005-2201
US

V. Phone/Fax

Practice location:
  • Phone: 212-514-6499
  • Fax: 212-514-6475
Mailing address:
  • Phone: 212-514-6499
  • Fax: 212-514-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number036765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: