Provider Demographics
NPI:1083807754
Name:ANAYA, SUSANA E (LMT)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:E
Last Name:ANAYA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:MONCADA
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-0600
Mailing Address - Country:US
Mailing Address - Phone:360-721-0501
Mailing Address - Fax:
Practice Address - Street 1:557 GOERIG ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9442
Practice Address - Country:US
Practice Address - Phone:360-721-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023755225700000X
WA000023755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023755OtherMASSAGE THERPY