Provider Demographics
NPI:1548204522
Name:WONG, SUEANNA SAN (PT)
Entity Type:Individual
Prefix:MS
First Name:SUEANNA
Middle Name:SAN
Last Name:WONG
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 1:2945 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2549
Mailing Address - Country:US
Mailing Address - Phone:650-755-8830
Mailing Address - Fax:650-755-8147
Practice Address - Street 1:2945 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2549
Practice Address - Country:US
Practice Address - Phone:650-755-8830
Practice Address - Fax:650-755-8147
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP.T.23793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist