Provider Demographics
NPI:1649510660
Name:CHRISTIANSON, SUSAN YVONNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:YVONNE
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:ME
Mailing Address - Zip Code:04963-3123
Mailing Address - Country:US
Mailing Address - Phone:207-615-4310
Mailing Address - Fax:
Practice Address - Street 1:921 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:ME
Practice Address - Zip Code:04963-3123
Practice Address - Country:US
Practice Address - Phone:207-615-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist