Provider Demographics
NPI:1770755738
Name:KNUTOWICZ, SUSAN MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:KNUTOWICZ
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:PO BOX 377437
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96737-7437
Mailing Address - Country:US
Mailing Address - Phone:808-443-4574
Mailing Address - Fax:
Practice Address - Street 1:75-5719 ALII DR STE V
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1754
Practice Address - Country:US
Practice Address - Phone:808-443-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9517225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist