Provider Demographics
NPI:1245703628
Name:CUGLE-LOPEZ, SUSAN KATHERINE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHERINE
Last Name:CUGLE-LOPEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KATHERINE
Other - Last Name:CUGLE-LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:2 SAINT ALBANS BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1800
Mailing Address - Country:US
Mailing Address - Phone:540-659-1474
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT ALBANS BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1800
Practice Address - Country:US
Practice Address - Phone:540-659-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist