MEDICARE: SARA MARIE PRATO RDN, CD, LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI 60129238	WA
2	225700000X	Massage Therapist	MA60012489	WA
3	133V00000X	Registered Dietitian	1003914

General Provider Information

NPI Number	:	1215194378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MARIE PRATO RDN, CD, LMP

Provider Business Mailing Address
First Line	:	10426 SKY POND LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-4513
Country	:	US
Telephone Number	:	707-832-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	7750 N UNION BLVD STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4051
Country	:	US
Telephone Number	:	719-445-6400
Fax Number	:	719-445-6405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	10/21/2022

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