Provider Demographics
NPI:1427184639
Name:PERANTEAU, SUZANNE (CMT, DIPL ABT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PERANTEAU
Suffix:
Gender:F
Credentials:CMT, DIPL ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 UNIVERSITY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2167
Mailing Address - Country:US
Mailing Address - Phone:608-588-5486
Mailing Address - Fax:608-616-5428
Practice Address - Street 1:12 GALLOWAY AVE
Practice Address - Street 2:STE 2F
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4931
Practice Address - Country:US
Practice Address - Phone:410-628-2068
Practice Address - Fax:410-628-2068
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM02767225700000X
WI11996-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist