Provider Demographics
NPI:1972718948
Name:ALIRE, SUSAN T (LMT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:T
Last Name:ALIRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:T
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:8165 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3848
Mailing Address - Country:US
Mailing Address - Phone:719-649-6267
Mailing Address - Fax:
Practice Address - Street 1:5606 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1940
Practice Address - Country:US
Practice Address - Phone:719-649-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist