Provider Demographics
NPI:1629659784
Name:SIMS, SARAH RAE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RAE
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SRAE
Other - Middle Name:BEAR
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:804 HAWTHORNE AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1926
Mailing Address - Country:US
Mailing Address - Phone:909-702-1303
Mailing Address - Fax:
Practice Address - Street 1:8530 EAGLE POINT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8648
Practice Address - Country:US
Practice Address - Phone:715-410-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist