Provider Demographics
NPI:1760695928
Name:MALIN, SUSAN WOOLLEY (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WOOLLEY
Last Name:MALIN
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 1:713 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5926
Mailing Address - Country:US
Mailing Address - Phone:303-772-6655
Mailing Address - Fax:303-772-1148
Practice Address - Street 1:713 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5926
Practice Address - Country:US
Practice Address - Phone:303-772-6655
Practice Address - Fax:303-772-1148
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist