Provider Demographics
NPI:1437479656
Name:VAN ATTA, SARA BETH (LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:VAN ATTA
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 1:8215 W BELL RD
Mailing Address - Street 2:#130
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:602-292-0141
Mailing Address - Fax:
Practice Address - Street 1:8215 W BELL RD
Practice Address - Street 2:#130
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3800
Practice Address - Country:US
Practice Address - Phone:602-292-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT10-385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist