Provider Demographics
NPI:1720449721
Name:SU, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SU
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:5729 LEBANON RD STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7259
Practice Address - Country:US
Practice Address - Phone:469-731-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCP036995T225100000X
MOCP035461T225100000X
NJCP036665T225100000X
TNCP025678T225100000X
NCCP024337T225100000X
ALCP036664T225100000X
GACP026050T225100000X
SCCP030876T225100000X
DECP030878T225100000X
INCP024333T225100000X
MI5501303019225100000X
KYCP024332T225100000X
LACP025677T225100000X
VACP030881T225100000X
TX1272243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist