Provider Demographics
NPI:1972680023
Name:BOWMAN, SUSAN AMY (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:AMY
Other - Last Name:REICHMUTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22019 HWY 99
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-774-2411
Mailing Address - Fax:425-672-7065
Practice Address - Street 1:22019 HWY 99
Practice Address - Street 2:SUITE A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-774-2411
Practice Address - Fax:425-672-7065
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist