Provider Demographics
NPI:1194019364
Name:NOVOTNY, SUSANNE LYNN (LMT, CDA)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:LYNN
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:LMT, CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 CRYSTAL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8666
Mailing Address - Country:US
Mailing Address - Phone:832-389-6692
Mailing Address - Fax:
Practice Address - Street 1:2126 CRYSTAL DOWNS DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8666
Practice Address - Country:US
Practice Address - Phone:832-389-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT112219172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist