Provider Demographics
NPI:1013329994
Name:CLARK, SARA (CMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 DANA DR STE C
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4036
Mailing Address - Country:US
Mailing Address - Phone:530-440-2322
Mailing Address - Fax:
Practice Address - Street 1:1007 DANA DR STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4036
Practice Address - Country:US
Practice Address - Phone:530-440-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist