Provider Demographics
NPI:1275653511
Name:SHREWSBURY, SUSAN (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHREWSBURY
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 1:8546 19TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3518
Mailing Address - Country:US
Mailing Address - Phone:206-783-3141
Mailing Address - Fax:206-784-5257
Practice Address - Street 1:8546 19TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3518
Practice Address - Country:US
Practice Address - Phone:206-783-3141
Practice Address - Fax:206-784-5257
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014762174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist