Provider Demographics
NPI:1477800886
Name:WILLIAMS, SUSIE XUE (DPT)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:XUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:XUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:19200 PRESTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2450
Mailing Address - Country:US
Mailing Address - Phone:469-200-2832
Mailing Address - Fax:469-269-1074
Practice Address - Street 1:5000 ELDORADO PKWY STE 430
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8608
Practice Address - Country:US
Practice Address - Phone:214-436-4606
Practice Address - Fax:214-436-4794
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1313724225100000X
MO2012024875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4370076OtherMEDICARE PTAN
47614055OtherBCBS-KC
KSKA2868056OtherMEDICARE PTAN