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General NPI Number Information
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NPI Number | 1629638762
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Entity Type | Individual
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Provider Name | EMILY TUM SUDEN DPT
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 21 GATEWAY CORNERS PARK STE 102
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City | COLUMBIA
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State | SC
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Zip | 29203-8906
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Country | US
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Telephone | 803-699-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 21 GATEWAY CORNERS PARK STE 102
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City | COLUMBIA
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State | SC
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Zip | 29203-8906
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Country | US
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Telephone | 803-699-9775
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Fax |
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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 | PT11374
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT014011
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT21377
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License Number State | NC
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