Provider Demographics
NPI:1821810177
Name:LLANES, SUFFIA PAULINE AMABLE (PT)
Entity type:Individual
Prefix:
First Name:SUFFIA PAULINE
Middle Name:AMABLE
Last Name:LLANES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2659
Mailing Address - Country:US
Mailing Address - Phone:470-399-1772
Mailing Address - Fax:
Practice Address - Street 1:19737 LEITERSBURG PIKE STE B
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1508
Practice Address - Country:US
Practice Address - Phone:301-714-0700
Practice Address - Fax:301-714-0703
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014574225100000X
MD29535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist