MEDICARE: MS. ASHLEY SUH MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	029804	NY

General Provider Information

NPI Number	:	1104265776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY SUH MSPT

Provider Business Mailing Address
First Line	:	4545 CENTER BLVD APT 615
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5912
Country	:	US
Telephone Number	:	917-733-4282
Fax Number	:

Provider Business Practice Location Address
First Line	:	4255 COLDEN ST
Second Line	:	APT 10B
City	:	FLUSHING
State	:	NY
Zip	:	11355-3937
Country	:	US
Telephone Number	:	917-733-4282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	11/22/2022

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