Healthcare Provider Details

I. General information

NPI: 1780657866
Provider Name (Legal Business Name): SUE A SZYMANSKI MT MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 W NORTH AVE #104
BROOKFIELD WI
53045-4366
US

IV. Provider business mailing address

17280 W NORTH AVE #104
BROOKFIELD WI
53045-4366
US

V. Phone/Fax

Practice location:
  • Phone: 262-780-0707
  • Fax: 262-780-0717
Mailing address:
  • Phone: 262-780-0707
  • Fax: 262-780-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1927046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: