Provider Demographics
NPI:1003461161
Name:PUAR, SARAH MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:PUAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:790 W 8TH AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5165
Mailing Address - Country:US
Mailing Address - Phone:541-852-0376
Mailing Address - Fax:
Practice Address - Street 1:790 W 8TH AVE STE 2A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5165
Practice Address - Country:US
Practice Address - Phone:541-852-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20856OtherOREGON STATE BOARD OF MASSAGE