Healthcare Provider Details

I. General information

NPI: 1477345973
Provider Name (Legal Business Name): SUSAN BUETTNER MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. SUSAN BUETTNER

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N 4TH AVE
TUCSON AZ
85705-8449
US

IV. Provider business mailing address

39130 S RODEO BUCKLE DR
TUCSON AZ
85739-5934
US

V. Phone/Fax

Practice location:
  • Phone: 520-907-4333
  • Fax:
Mailing address:
  • Phone: 520-743-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-20373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: