Provider Demographics
NPI:1639469158
Name:FARHAT, SUSAN (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FARHAT
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 1:9114 58TH DR E
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9074
Mailing Address - Country:US
Mailing Address - Phone:941-320-9951
Mailing Address - Fax:
Practice Address - Street 1:9114 58TH DR E
Practice Address - Street 2:SUITE 112
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-9074
Practice Address - Country:US
Practice Address - Phone:941-320-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA36096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist