Provider Demographics
NPI:1750563052
Name:MALENFANT, SARA DB (LMT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DB
Last Name:MALENFANT
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:PO BOX 81115
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-1115
Mailing Address - Country:US
Mailing Address - Phone:907-488-3621
Mailing Address - Fax:
Practice Address - Street 1:530 7TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4934
Practice Address - Country:US
Practice Address - Phone:907-488-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK812199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist