Provider Demographics
NPI:1912425794
Name:NELSON, SARAH JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:EIDUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18755 MULLAN RD
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-9629
Mailing Address - Country:US
Mailing Address - Phone:406-381-5127
Mailing Address - Fax:
Practice Address - Street 1:2801 GREAT NORTHERN LOOP
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1745
Practice Address - Country:US
Practice Address - Phone:406-549-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLIC-LIC-LMT-11970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist