Provider Demographics
NPI:1750870069
Name:SUH, THOMAS JAY (PT, DPT, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAY
Last Name:SUH
Suffix:
Gender:M
Credentials:PT, DPT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 EMPEROR CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-8607
Mailing Address - Country:US
Mailing Address - Phone:512-590-9581
Mailing Address - Fax:
Practice Address - Street 1:715 DISCOVERY BLVD STE 411
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2417
Practice Address - Country:US
Practice Address - Phone:512-260-9600
Practice Address - Fax:512-260-9601
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1303875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist