Provider Demographics
NPI:1386539658
Name:HERZIG, SUZAN
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:HERZIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CLEMENTS ST NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6427
Mailing Address - Country:US
Mailing Address - Phone:619-817-6559
Mailing Address - Fax:
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 11
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5257
Practice Address - Country:US
Practice Address - Phone:850-716-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist