Provider Demographics
NPI:1831687276
Name:WEIDEN, SARAH J
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:WEIDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:WEIDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WEIDEN YOUR ABILITY
Mailing Address - Street 1:2353 MONICA LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2584
Mailing Address - Country:US
Mailing Address - Phone:231-740-5759
Mailing Address - Fax:
Practice Address - Street 1:1040 E STERNBERG RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-740-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist