Provider Demographics
NPI:1902000870
Name:SARGENT, MINDY A (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:A
Last Name:SARGENT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:A
Other - Last Name:SARGENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:1009 W GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5309
Mailing Address - Country:US
Mailing Address - Phone:850-288-9245
Mailing Address - Fax:
Practice Address - Street 1:1009 W GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5309
Practice Address - Country:US
Practice Address - Phone:850-288-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA#31556OtherMASSAGE THERAPIST