MEDICARE: SUZANNE KUSSNER LMT

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	28722	OR

General Provider Information

NPI Number	:	1710833447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE KUSSNER LMT

Provider Business Mailing Address
First Line	:	3580 SE HARRISON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-5878
Country	:	US
Telephone Number	:	808-419-4739
Fax Number	:

Provider Business Practice Location Address
First Line	:	3580 SE HARRISON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-5878
Country	:	US
Telephone Number	:	808-419-4739
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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