Provider Demographics
NPI:1487041885
Name:DUTT, SARAH (LMT, LR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DUTT
Suffix:
Gender:F
Credentials:LMT, LR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 9TH ST E
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3381
Mailing Address - Country:US
Mailing Address - Phone:701-364-2739
Mailing Address - Fax:701-373-0037
Practice Address - Street 1:1420 9TH ST E
Practice Address - Street 2:SUITE 401
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3381
Practice Address - Country:US
Practice Address - Phone:701-364-2739
Practice Address - Fax:701-373-0037
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist