Provider Demographics
NPI:1316758279
Name:PONTIUS, SUSAN MARIE (CMT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 QUADAY AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6662
Mailing Address - Country:US
Mailing Address - Phone:763-274-0373
Mailing Address - Fax:
Practice Address - Street 1:9125 QUADAY AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6662
Practice Address - Country:US
Practice Address - Phone:763-274-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist