Provider Demographics
NPI:1972655181
Name:MAYS, SUSAN ALICE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ALICE
Last Name:MAYS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15818 SE 175TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9122
Mailing Address - Country:US
Mailing Address - Phone:425-260-3707
Mailing Address - Fax:
Practice Address - Street 1:4608 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5004
Practice Address - Country:US
Practice Address - Phone:425-226-6261
Practice Address - Fax:425-917-5325
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist