Provider Demographics
NPI:1477785632
Name:MCCANN/ MAYO, SARA KRISTIN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:KRISTIN
Last Name:MCCANN/ MAYO
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 1:304 PINE ARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6540
Mailing Address - Country:US
Mailing Address - Phone:904-655-8683
Mailing Address - Fax:
Practice Address - Street 1:304 PINE ARBOR CIR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6540
Practice Address - Country:US
Practice Address - Phone:904-655-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51342172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist