Provider Demographics
NPI:1669255733
Name:SU, ERICA RENA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RENA
Last Name:SU
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 CONNELL FARM DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6022
Mailing Address - Country:US
Mailing Address - Phone:972-809-7880
Mailing Address - Fax:
Practice Address - Street 1:4825 ALLIANCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5504
Practice Address - Country:US
Practice Address - Phone:469-606-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1381050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation