Provider Demographics
NPI:1508296880
Name:LINDBERG, SUZANNAH
Entity Type:Individual
Prefix:
First Name:SUZANNAH
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0517
Mailing Address - Country:US
Mailing Address - Phone:208-908-9757
Mailing Address - Fax:
Practice Address - Street 1:5246 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0945
Practice Address - Country:US
Practice Address - Phone:208-939-3000
Practice Address - Fax:208-939-3030
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-7225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist