Provider Demographics
NPI:1295254951
Name:GILBERT, SUSAN ELIZABETH (LMT, CYT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LMT, CYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 IOWA ST APT 413
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4087
Mailing Address - Country:US
Mailing Address - Phone:619-248-6866
Mailing Address - Fax:
Practice Address - Street 1:3910 NORMAL ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3488
Practice Address - Country:US
Practice Address - Phone:619-248-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherASH