Provider Demographics
NPI:1700483682
Name:SUEYOSHI, TETSURO (ATC)
Entity Type:Individual
Prefix:
First Name:TETSURO
Middle Name:
Last Name:SUEYOSHI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:SUEYOSHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:1 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89437-4429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89437-4429
Practice Address - Country:US
Practice Address - Phone:775-343-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05066112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer