Provider Demographics
NPI:1336814649
Name:SU, THEODORE (DPT)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2453
Mailing Address - Country:US
Mailing Address - Phone:877-234-8034
Mailing Address - Fax:713-430-4046
Practice Address - Street 1:13425 SE 30TH ST STE 2C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4450
Practice Address - Country:US
Practice Address - Phone:425-800-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61382998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist