Provider Demographics
NPI:1710128004
Name:WHITE, SUZANNE LINDA
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LINDA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-7031
Mailing Address - Country:US
Mailing Address - Phone:207-749-8417
Mailing Address - Fax:
Practice Address - Street 1:3 EASTVIEW PKWY
Practice Address - Street 2:SUITE # 3
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-6701
Practice Address - Country:US
Practice Address - Phone:207-749-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT162172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist