Provider Demographics
NPI:1003127911
Name:MEAGHER, SUSAN D (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:MEAGHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 E TURNER CAMP RD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-1448
Mailing Address - Country:US
Mailing Address - Phone:352-476-5778
Mailing Address - Fax:352-419-5631
Practice Address - Street 1:1241 E NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-4552
Practice Address - Country:US
Practice Address - Phone:352-476-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2448OtherBCBSFL