Provider Demographics
NPI:1568750313
Name:BOUGHTON, SUSAN MARGARET (LMT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARGARET
Last Name:BOUGHTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5067 S EVANSTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2203
Mailing Address - Country:US
Mailing Address - Phone:303-521-4632
Mailing Address - Fax:
Practice Address - Street 1:5067 S EVANSTON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2203
Practice Address - Country:US
Practice Address - Phone:303-521-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2606225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist