Provider Demographics
NPI:1841426616
Name:REID, SUSAN LORRAINE (LMT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LORRAINE
Last Name:REID
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 1:1028 COMMODORE ST
Mailing Address - Street 2:APT 4
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1014
Mailing Address - Country:US
Mailing Address - Phone:727-543-2144
Mailing Address - Fax:
Practice Address - Street 1:8209 113TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4128
Practice Address - Country:US
Practice Address - Phone:727-543-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA6609172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1838OtherBLUE CROSS BLUE SHEILD