Provider Demographics
NPI:1346806189
Name:CASPERSON, SARAH NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:CASPERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 HUNTING TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-3536
Mailing Address - Country:US
Mailing Address - Phone:954-562-9095
Mailing Address - Fax:
Practice Address - Street 1:4586 HUNTING TRL
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-3536
Practice Address - Country:US
Practice Address - Phone:954-562-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA92570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist