Healthcare Provider Details

I. General information

NPI: 1710829569
Provider Name (Legal Business Name): SUSAN P CARR MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 OAK RUN TRL UNIT 212
OAK PARK CA
91377-5628
US

IV. Provider business mailing address

675 OAK RUN TRL UNIT 212
OAK PARK CA
91377-5628
US

V. Phone/Fax

Practice location:
  • Phone: 818-370-6573
  • Fax:
Mailing address:
  • Phone: 818-370-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number2629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: