Provider Demographics
NPI:1114045283
Name:BORYS, SUSAN K (LMP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:BORYS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17811 HALL RD KPN
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394
Mailing Address - Country:US
Mailing Address - Phone:253-884-5003
Mailing Address - Fax:
Practice Address - Street 1:8903 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9326
Practice Address - Country:US
Practice Address - Phone:253-884-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist