Provider Demographics
NPI:1508880311
Name:PERDOS, SUSAN MARINA (RN, NCTMB, LMT, CCHT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARINA
Last Name:PERDOS
Suffix:
Gender:F
Credentials:RN, NCTMB, LMT, CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5486 WOODLAND PL
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9506
Mailing Address - Country:US
Mailing Address - Phone:330-519-4247
Mailing Address - Fax:330-533-6678
Practice Address - Street 1:5486 WOODLAND PL
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9506
Practice Address - Country:US
Practice Address - Phone:330-519-4247
Practice Address - Fax:330-533-6678
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN269374163WM1400X, 163W00000X, 175L00000X, 175F00000X
WV20032345225700000X
PA308981-00225700000X, 163WM1400X
PARN509068L175L00000X, 175F00000X, 163W00000X
WV2003-1345163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered175L00000XOther Service ProvidersHomeopath
Not Answered175F00000XOther Service ProvidersNaturopath