Provider Demographics
NPI:1306393343
Name:SUY, SALY
Entity type:Individual
Prefix:
First Name:SALY
Middle Name:
Last Name:SUY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8052
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98419-0052
Mailing Address - Country:US
Mailing Address - Phone:253-376-0277
Mailing Address - Fax:
Practice Address - Street 1:4102 S MERIDIAN
Practice Address - Street 2:STE E5
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5962
Practice Address - Country:US
Practice Address - Phone:253-282-2326
Practice Address - Fax:844-517-6511
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60550953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist