Provider Demographics
NPI:1861065070
Name:SU, STEPHEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SU
Suffix:
Gender:M
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 1:502 CORTEZ RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6430
Mailing Address - Country:US
Mailing Address - Phone:626-716-2202
Mailing Address - Fax:
Practice Address - Street 1:502 CORTEZ RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6430
Practice Address - Country:US
Practice Address - Phone:626-716-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty