Healthcare Provider Details

I. General information

NPI: 1194051078
Provider Name (Legal Business Name): SABRINA MARIE THUMMEL M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9745 N K92 HWY
MC LOUTH KS
66054-4257
US

IV. Provider business mailing address

9745 N K92 HWY
MC LOUTH KS
66054-4257
US

V. Phone/Fax

Practice location:
  • Phone: 913-796-6652
  • Fax:
Mailing address:
  • Phone: 913-796-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNONE
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: