Healthcare Provider Details

I. General information

NPI: 1841826104
Provider Name (Legal Business Name): SARAH SYLLA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/08/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST W
WABASHA MN
55981-1236
US

IV. Provider business mailing address

S 545 STATE HWY/RD 25
DURAND/MAXVILLE WI
54736
US

V. Phone/Fax

Practice location:
  • Phone: 651-565-4863
  • Fax:
Mailing address:
  • Phone: 715-279-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11786-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: