MEDICARE: MS. SUSAN A. THOMAS LMP

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
1	225700000X	Massage Therapist	MA60195553	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA60195553	OTHER	WA	WA STATE DOH LICENSE

General Provider Information

NPI Number	:	1700180064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN A. THOMAS LMP

Provider Business Mailing Address
First Line	:	PO BOX 8
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-0008
Country	:	US
Telephone Number	:	206-919-7747
Fax Number	:	206-686-3565

Provider Business Practice Location Address
First Line	:	4137 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4101
Country	:	US
Telephone Number	:	206-919-7747
Fax Number	:	206-686-3565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2010
Last Update Date	:	09/13/2022

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