Healthcare Provider Details

I. General information

NPI: 1245396522
Provider Name (Legal Business Name): SARAH MICHELLE HARVIEUX PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N ACRES RD STE 60
PRESCOTT WI
54021-7039
US

IV. Provider business mailing address

5097 MARQUESS TRAIL CIR N
LAKE ELMO MN
55042-4401
US

V. Phone/Fax

Practice location:
  • Phone: 651-404-1030
  • Fax: 651-404-1035
Mailing address:
  • Phone: 651-216-6125
  • Fax: 715-426-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8940
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9981-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: