Provider Demographics
NPI:1508117912
Name:KASALA, SUZYN (LMP)
Entity Type:Individual
Prefix:
First Name:SUZYN
Middle Name:
Last Name:KASALA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0010
Mailing Address - Country:US
Mailing Address - Phone:425-681-5900
Mailing Address - Fax:
Practice Address - Street 1:1595 NW GILMAN BLVD STE 15
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5329
Practice Address - Country:US
Practice Address - Phone:425-681-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60303828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist