Provider Demographics
NPI:1174677520
Name:SUEOKA, STEPHANIE KUNIE (MPT, DPT, CHT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KUNIE
Last Name:SUEOKA
Suffix:
Gender:F
Credentials:MPT, DPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 WAKARA WAY
Mailing Address - Street 2:ORTHOPEADIC CENTER
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1200
Mailing Address - Country:US
Mailing Address - Phone:801-587-7001
Mailing Address - Fax:801-587-7004
Practice Address - Street 1:590 WAKARA WAY
Practice Address - Street 2:ORTHOPEADIC CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1200
Practice Address - Country:US
Practice Address - Phone:801-587-7001
Practice Address - Fax:801-587-7004
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2674422-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist