Provider Demographics
NPI:1700180064
Name:THOMAS, SUSAN A (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-0008
Mailing Address - Country:US
Mailing Address - Phone:206-919-7747
Mailing Address - Fax:206-686-3565
Practice Address - Street 1:4137 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4101
Practice Address - Country:US
Practice Address - Phone:206-919-7747
Practice Address - Fax:206-686-3565
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60195553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60195553OtherWA STATE DOH LICENSE