Provider Demographics
NPI:1154770196
Name:LUCKEY-RIMBERG, SUSANNE MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MARIE
Last Name:LUCKEY-RIMBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2667
Mailing Address - Country:US
Mailing Address - Phone:254-939-5801
Mailing Address - Fax:
Practice Address - Street 1:401 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2667
Practice Address - Country:US
Practice Address - Phone:254-939-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT119285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist