Provider Demographics
NPI:1265821441
Name:MATTINGLEY, SARAH (RMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MATTINGLEY
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W OAK ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-7106
Mailing Address - Country:US
Mailing Address - Phone:970-217-7617
Mailing Address - Fax:
Practice Address - Street 1:151 W OAK ST
Practice Address - Street 2:SUITE 119
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-7106
Practice Address - Country:US
Practice Address - Phone:970-217-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0007112225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist