Provider Demographics
NPI:1710497292
Name:SUDDES, SARA A (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:SUDDES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-199 HOAHELE PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5544
Mailing Address - Country:US
Mailing Address - Phone:808-674-0500
Mailing Address - Fax:808-674-0511
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 207
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3968
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:808-486-8674
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist