Provider Demographics
NPI:1457421331
Name:VARNEY, SUSAN DENISE (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:VARNEY
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 CYPRESS LEGENDS CIR APT 1006
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5539
Mailing Address - Country:US
Mailing Address - Phone:207-450-9358
Mailing Address - Fax:239-674-9140
Practice Address - Street 1:3329 CYPRESS LEGENDS CIR APT 1006
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5539
Practice Address - Country:US
Practice Address - Phone:207-450-9358
Practice Address - Fax:239-674-9140
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52 622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 52 622OtherDEPT OF HEALTH
ME444218-00OtherNAT'L MASSAGE CERTIFICATE