Provider Demographics
NPI:1760507107
Name:SUESS, PHILIP M III (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:M
Last Name:SUESS
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5248
Mailing Address - Country:US
Mailing Address - Phone:912-283-7342
Mailing Address - Fax:912-283-7402
Practice Address - Street 1:401 PRESTON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5248
Practice Address - Country:US
Practice Address - Phone:912-283-7342
Practice Address - Fax:912-283-7402
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist