Provider Demographics
NPI:1932409471
Name:HAXTON, SUZETTE IRENE
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:IRENE
Last Name:HAXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 TAMIAMI TRL
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-3802
Mailing Address - Country:US
Mailing Address - Phone:941-628-8904
Mailing Address - Fax:
Practice Address - Street 1:1032 TAMIAMI TRL
Practice Address - Street 2:UNIT 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3802
Practice Address - Country:US
Practice Address - Phone:941-628-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA25939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist