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General NPI Number Information
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NPI Number | 1336814649
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Entity Type | Individual
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Provider Name | THEODORE SU DPT
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Gender | Male
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 13425 SE 30TH ST STE 2C
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City | BELLEVUE
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State | WA
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Zip | 98005-4450
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Country | US
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Telephone | 425-800-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 W SAM HOUSTON PKWY S STE 300
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City | HOUSTON
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State | TX
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Zip | 77042-2453
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Country | US
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Telephone | 877-234-8034
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Fax | 713-430-4046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61382998
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License Number State | WA
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