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NPI Code Detail

MEDICARE: SUSY GRANADOS MA60876400

MEDICARE: SUSY GRANADOS MA60876400
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA60876400WA

General Provider Information

NPI Number : 1588228761
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSY GRANADOS MA60876400
Provider Business Mailing Address
First Line : 11030 EVERGREEN WAY STE A
Second Line :
City : EVERETT
State : WA
Zip : 98204-6633
Country : US
Telephone Number : 425-239-1974
Fax Number :
Provider Business Practice Location Address
First Line : 610 BEACH AVE STE 1
Second Line :
City : MARYSVILLE
State : WA
Zip : 98270-4571
Country : US
Telephone Number : 425-422-1558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2019
Last Update Date : 07/06/2022

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Directions to “ SUSY GRANADOS MA60876400” Practice Location

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