Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1180530 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1180530 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1180530 | TX |
NPI | 1508116625 |
---|---|
Provider Name | Mrs. Susana D Demore |
First Address | Houston, TX 77042-2453 |
Second Address | Houston, TX 77042-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 16/11/2020 |