Provider Demographics
NPI:1679027536
Name:MOSQUEDA, SARA MARIE (LM T)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:MARIE
Last Name:MOSQUEDA
Suffix:
Gender:F
Credentials:LM T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1860 STATE ROAD 436
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2255
Mailing Address - Country:US
Mailing Address - Phone:407-657-5029
Mailing Address - Fax:407-657-6320
Practice Address - Street 1:1860 STATE ROAD 436
Practice Address - Street 2:SUITE 1000
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2255
Practice Address - Country:US
Practice Address - Phone:407-657-5029
Practice Address - Fax:407-657-6320
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist