Provider Demographics
NPI:1245396522
Name:HARVIEUX, SARAH MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:HARVIEUX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5097 MARQUESS TRAIL CIR N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-4401
Mailing Address - Country:US
Mailing Address - Phone:651-216-6125
Mailing Address - Fax:715-426-4602
Practice Address - Street 1:1400 N ACRES RD STE 60
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021-7039
Practice Address - Country:US
Practice Address - Phone:651-404-1030
Practice Address - Fax:651-404-1035
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8940225100000X
WI9981-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36103100Medicaid