Provider Demographics
NPI:1568282911
Name:FONG SUET YUEN, JENNY CALARA (PT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:CALARA
Last Name:FONG SUET YUEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 FIREWHEEL PKWY APT 5203
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4163
Mailing Address - Country:US
Mailing Address - Phone:972-703-3188
Mailing Address - Fax:
Practice Address - Street 1:4430 LAVON DR STE 340
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2974
Practice Address - Country:US
Practice Address - Phone:972-495-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1400787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist