Provider Demographics
NPI:1104265776
Name:SUH, ASHLEY (MSPT)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CENTER BLVD APT 615
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5912
Mailing Address - Country:US
Mailing Address - Phone:917-733-4282
Mailing Address - Fax:
Practice Address - Street 1:4255 COLDEN ST
Practice Address - Street 2:APT 10B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3937
Practice Address - Country:US
Practice Address - Phone:917-733-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist