Provider Demographics
NPI:1528591922
Name:PALUMBO, SUSAN DIANE (LMT, CNMT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2704 WREN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1152
Mailing Address - Country:US
Mailing Address - Phone:719-426-7010
Mailing Address - Fax:
Practice Address - Street 1:620 S CASCADE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4039
Practice Address - Country:US
Practice Address - Phone:719-426-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist