Provider Demographics
NPI:1255408712
Name:MASSARO, SARA STUTSMAN (PT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:STUTSMAN
Last Name:MASSARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:STUTSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4540 OAK CHASE LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2804
Mailing Address - Country:US
Mailing Address - Phone:651-688-7407
Mailing Address - Fax:651-688-6389
Practice Address - Street 1:4660 SLATER RD
Practice Address - Street 2:SUITE #130
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4047
Practice Address - Country:US
Practice Address - Phone:651-260-3774
Practice Address - Fax:651-688-6389
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist