Provider Demographics
NPI:1033283791
Name:LIM-LUY, SUZANNE JOSEPHINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:JOSEPHINE
Last Name:LIM-LUY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE - JOY
Other - Middle Name:JOSEPHINE
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2782 N HIGHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1797
Mailing Address - Country:US
Mailing Address - Phone:731-664-1172
Mailing Address - Fax:731-664-3139
Practice Address - Street 1:2782 N HIGHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1797
Practice Address - Country:US
Practice Address - Phone:731-664-1172
Practice Address - Fax:731-664-3139
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1841247418OtherGROUP NPI