Provider Demographics
NPI:1982067856
Name:MEYER, SUSAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MEYER
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 1:3418 HANDY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4603
Mailing Address - Country:US
Mailing Address - Phone:813-239-4120
Mailing Address - Fax:
Practice Address - Street 1:3418 HANDY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4603
Practice Address - Country:US
Practice Address - Phone:813-239-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA25167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist