Provider Demographics
NPI:1649008236
Name:ELLINGSON, SARAH (CMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ELLINGSON
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 1:1915 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3304
Mailing Address - Country:US
Mailing Address - Phone:408-607-7430
Mailing Address - Fax:
Practice Address - Street 1:25 W 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4559
Practice Address - Country:US
Practice Address - Phone:408-607-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist