Provider Demographics
NPI:1205261351
Name:SARGENT, TERESA K (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:SARGENT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:ME
Mailing Address - Zip Code:04966-4122
Mailing Address - Country:US
Mailing Address - Phone:207-639-2939
Mailing Address - Fax:
Practice Address - Street 1:100 BRAY HILL RD
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:ME
Practice Address - Zip Code:04966-4122
Practice Address - Country:US
Practice Address - Phone:207-639-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist