Provider Demographics
NPI:1710156914
Name:LANE, SUSANNE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2534
Mailing Address - Country:US
Mailing Address - Phone:508-580-1544
Mailing Address - Fax:508-580-1967
Practice Address - Street 1:471 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2534
Practice Address - Country:US
Practice Address - Phone:508-580-1544
Practice Address - Fax:508-580-1967
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist