Provider Demographics
NPI:1003154667
Name:BEAUDRY, SARA (MSS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:MSS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2163
Mailing Address - Country:US
Mailing Address - Phone:801-830-0188
Mailing Address - Fax:
Practice Address - Street 1:1840 S 1300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3617
Practice Address - Country:US
Practice Address - Phone:801-832-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6323994-4810171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor