Provider Demographics
NPI:1023644705
Name:GILES, SARAH J (MT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:GILES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 KANSAS CITY ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3668
Mailing Address - Country:US
Mailing Address - Phone:605-545-7591
Mailing Address - Fax:
Practice Address - Street 1:429 KANSAS CITY ST STE 1B
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3668
Practice Address - Country:US
Practice Address - Phone:605-545-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty