Provider Demographics
NPI:1740714708
Name:SANDVOLD, EMILY ELAINE (LMT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELAINE
Last Name:SANDVOLD
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 1:424 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1213
Mailing Address - Country:US
Mailing Address - Phone:712-592-2778
Mailing Address - Fax:
Practice Address - Street 1:424 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-1213
Practice Address - Country:US
Practice Address - Phone:712-592-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist