Provider Demographics
NPI:1992709539
Name:LIM, SU S (PT)
Entity type:Individual
Prefix:MRS
First Name:SU
Middle Name:S
Last Name:LIM
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 1:8500 BLUFFSTONE CV
Mailing Address - Street 2:STE B201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7812
Mailing Address - Country:US
Mailing Address - Phone:512-832-9830
Mailing Address - Fax:
Practice Address - Street 1:8500 BLUFFSTONE CV
Practice Address - Street 2:STE B201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7812
Practice Address - Country:US
Practice Address - Phone:512-832-9830
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650282Medicare ID - Type UnspecifiedPROVIDER