Basic Information
Provider Information
NPI: 1003142928
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUBBE
FirstName: SARAH
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: CMT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1690 BROWN COURT
Address2:  
City: LONGMONT
State: CO
PostalCode: 80503
CountryCode: US
TelephoneNumber: 3036849290
FaxNumber: 3037729308
Practice Location
Address1: 1690 BROWN COURT
Address2:  
City: LONGMONT
State: CO
PostalCode: 80503
CountryCode: US
TelephoneNumber: 3036849290
FaxNumber: 3037729308
Other Information
ProviderEnumerationDate: 10/28/2009
LastUpdateDate: 10/28/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000X4310COY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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