Provider Demographics
NPI:1952148868
Name:STREET, SARAH (LAC, LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36205 US HIGHWAY 24 N
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-9694
Mailing Address - Country:US
Mailing Address - Phone:970-215-3787
Mailing Address - Fax:
Practice Address - Street 1:28350 COUNTY ROAD 317 UNIT 7
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9261
Practice Address - Country:US
Practice Address - Phone:970-215-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3869225700000X
CO2494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist