Provider Demographics
NPI:1003295155
Name:WEBB, SUZANNE (MT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833-1398
Mailing Address - Country:US
Mailing Address - Phone:501-502-0464
Mailing Address - Fax:
Practice Address - Street 1:15 NORTH 12TH STREET
Practice Address - Street 2:SUITE 222
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833-1398
Practice Address - Country:US
Practice Address - Phone:501-502-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist