Healthcare Provider Details

I. General information

NPI: 1699049965
Provider Name (Legal Business Name): MICHELE SUOZZI LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 SARDIS RD N SUITE 207
CHARLOTTE NC
28270-1426
US

IV. Provider business mailing address

1811 SARDIS RD N SUITE 207
CHARLOTTE NC
28270-1426
US

V. Phone/Fax

Practice location:
  • Phone: 704-340-4663
  • Fax:
Mailing address:
  • Phone: 704-340-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNC2376
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberNC2376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: