Provider Demographics
NPI:1487125654
Name:LAND, SUSAN (LMT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LAND
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 1:848 N SUNRISE BLVD
Mailing Address - Street 2:STE 102 BLD A
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282
Mailing Address - Country:US
Mailing Address - Phone:360-629-2524
Mailing Address - Fax:360-610-4979
Practice Address - Street 1:848 N SUNRISE BLVD
Practice Address - Street 2:STE 102 BLD A
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282
Practice Address - Country:US
Practice Address - Phone:360-629-2524
Practice Address - Fax:360-610-4979
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAME60877736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60877736OtherLICENSED MASSAGE THERAPIST