Provider Demographics
NPI:1508685991
Name:SUTER, CASSANDRA (LMT, LAC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SUTER
Suffix:
Gender:F
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4244 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MORAN
Mailing Address - State:MI
Mailing Address - Zip Code:49760-9815
Mailing Address - Country:US
Mailing Address - Phone:906-430-9190
Mailing Address - Fax:
Practice Address - Street 1:703 STATE A ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1132
Practice Address - Country:US
Practice Address - Phone:906-430-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016536225700000X
MI5402000299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist