Healthcare Provider Details

I. General information

NPI: 1114045283
Provider Name (Legal Business Name): SUSAN K BORYS L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

17811 HALL RD KPN
VAUGHN WA
98394
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-6150
  • Fax:
Mailing address:
  • Phone: 253-884-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00003181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: