Provider Demographics
NPI:1639204365
Name:FERROZZO, SUSAN PATRICIA (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PATRICIA
Last Name:FERROZZO
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 1:505 N ARGONNE RD
Mailing Address - Street 2:SUITE BL2
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2869
Mailing Address - Country:US
Mailing Address - Phone:509-879-2633
Mailing Address - Fax:
Practice Address - Street 1:505 N ARGONNE RD
Practice Address - Street 2:SUITE BL2
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2869
Practice Address - Country:US
Practice Address - Phone:509-879-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist