Provider Demographics
NPI:1184123937
Name:CARR, SARAH THERESA (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:THERESA
Last Name:CARR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WESTBROOK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1808
Mailing Address - Country:US
Mailing Address - Phone:315-876-0349
Mailing Address - Fax:
Practice Address - Street 1:6499 E SENECA TPKE
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-2800
Practice Address - Country:US
Practice Address - Phone:315-876-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist