Provider Demographics
NPI:1336506989
Name:MEHL, SUZANNE (LMT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MEHL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 S 143RD PL
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3668
Mailing Address - Country:US
Mailing Address - Phone:206-361-1802
Mailing Address - Fax:
Practice Address - Street 1:850 S 143RD PL
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-3668
Practice Address - Country:US
Practice Address - Phone:206-361-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist