Provider Demographics
NPI:1407928252
Name:POWERS, SUSAN NELLE (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NELLE
Last Name:POWERS
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 1:2402 ROUTE 20 EAST
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035
Mailing Address - Country:US
Mailing Address - Phone:315-682-0654
Mailing Address - Fax:
Practice Address - Street 1:2402 ROUTE 20 EAST
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035
Practice Address - Country:US
Practice Address - Phone:315-682-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist