Healthcare Provider Details

I. General information

NPI: 1982923561
Provider Name (Legal Business Name): SUSAN E PARTLOW LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2010
Last Update Date: 05/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MAIN ST
CANTON NC
28716-4440
US

IV. Provider business mailing address

212 HILLCREST ST
CANTON NC
28716-4623
US

V. Phone/Fax

Practice location:
  • Phone: 828-246-2741
  • Fax:
Mailing address:
  • Phone: 828-648-3634
  • Fax: 828-648-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNC4479
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: