Provider Demographics
NPI:1578994000
Name:MOSSER, SARA D (ATC, LAT, MBA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:D
Last Name:MOSSER
Suffix:
Gender:F
Credentials:ATC, LAT, MBA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:D
Other - Last Name:BLINDAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT, MBA
Mailing Address - Street 1:1914 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2037
Mailing Address - Country:US
Mailing Address - Phone:920-980-7086
Mailing Address - Fax:
Practice Address - Street 1:2926 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4005
Practice Address - Country:US
Practice Address - Phone:920-803-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1354-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer