Healthcare Provider Details

I. General information

NPI: 1578757407
Provider Name (Legal Business Name): SUZETTE EDWIN CHAPMAN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZETTE EDWIN CHAPMAN LICENSE MASSAGE THER

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3403
US

IV. Provider business mailing address

164 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3403
US

V. Phone/Fax

Practice location:
  • Phone: 305-945-7246
  • Fax: 305-945-7246
Mailing address:
  • Phone: 305-945-7246
  • Fax: 305-945-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA32691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: