Provider Demographics
NPI:1457014854
Name:RAMIREZ, SUSANA NADINE (MT118041)
Entity Type:Individual
Prefix:MISS
First Name:SUSANA
Middle Name:NADINE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MT118041
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 GENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-8807
Mailing Address - Country:US
Mailing Address - Phone:469-996-1515
Mailing Address - Fax:
Practice Address - Street 1:609 GENTRY LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-8807
Practice Address - Country:US
Practice Address - Phone:469-996-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT118041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist