Provider Demographics
NPI:1922452572
Name:DEUR, SARAH (LPTA, LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DEUR
Suffix:
Gender:F
Credentials:LPTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 AGAWA TRL NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8524
Mailing Address - Country:US
Mailing Address - Phone:616-430-2093
Mailing Address - Fax:
Practice Address - Street 1:7500 AGAWA TRL NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8524
Practice Address - Country:US
Practice Address - Phone:616-430-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI75010000864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist