Provider Demographics
NPI:1982964888
Name:GANTENBEIN, SARAH D (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:D
Last Name:GANTENBEIN
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 1:7478 E TURTLE BANK DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-8343
Mailing Address - Country:US
Mailing Address - Phone:615-305-8780
Mailing Address - Fax:
Practice Address - Street 1:7478 E TURTLE BANK DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8343
Practice Address - Country:US
Practice Address - Phone:615-305-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-16834225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist