Provider Demographics
NPI:1922830942
Name:MCMUNN, SARAH (LMT, CMLDT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MCMUNN
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3048
Mailing Address - Country:US
Mailing Address - Phone:312-813-4242
Mailing Address - Fax:
Practice Address - Street 1:2453 ATWOOD AVE STE 210
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5655
Practice Address - Country:US
Practice Address - Phone:608-203-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17270-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist