Provider Demographics
NPI:1770656084
Name:GUDE, E SUZANNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:E
Middle Name:SUZANNE
Last Name:GUDE
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 1:101 MANOR AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-3212
Mailing Address - Country:US
Mailing Address - Phone:502-349-7799
Mailing Address - Fax:502-349-7799
Practice Address - Street 1:101 MANOR AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-3212
Practice Address - Country:US
Practice Address - Phone:502-349-7799
Practice Address - Fax:502-349-7799
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0412225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist