Provider Demographics
NPI:1679061618
Name:ALTAEAN, SARA ELIZABETH NICOLE
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH NICOLE
Last Name:ALTAEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:ELIZABETH NICOLE
Other - Last Name:ALTAEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7656 JEFFERSON HWY SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-928-8686
Mailing Address - Fax:225-928-8485
Practice Address - Street 1:ABILITY MASSAGE & DAY SPA
Practice Address - Street 2:7656 JEFFERSON HWY SUITE 1A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-928-8686
Practice Address - Fax:225-928-8485
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8294225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist