Provider Demographics
NPI:1710928262
Name:KUANFUNG, SARA L (PT, LMT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:KUANFUNG
Suffix:
Gender:F
Credentials:PT, LMT
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:BOOHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:128 ENCHANTED PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5497
Mailing Address - Country:US
Mailing Address - Phone:314-881-8590
Mailing Address - Fax:
Practice Address - Street 1:128 ENCHANTED PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-5497
Practice Address - Country:US
Practice Address - Phone:314-881-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0835225100000X
MO2013003489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist