MEDICARE: YOUNGSOO SUH RPT

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	PT7877	FL

General Provider Information

NPI Number	:	1649837915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNGSOO SUH RPT

Provider Business Mailing Address
First Line	:	2901 W SAINT ISABEL ST STE A2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6350
Country	:	US
Telephone Number	:	813-644-7017
Fax Number	:	813-644-7018

Provider Business Practice Location Address
First Line	:	2901 W SAINT ISABEL ST STE A2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6350
Country	:	US
Telephone Number	:	813-644-7017
Fax Number	:	813-644-7018

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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Directions to “ YOUNGSOO SUH RPT” Practice Location

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