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General NPI Number Information
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NPI Number | 1629659784
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Entity Type | Individual
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Provider Name | SARAH RAE SIMS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 8530 EAGLE POINT BLVD STE 100
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City | LAKE ELMO
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State | MN
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Zip | 55042-8648
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Country | US
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Telephone | 715-410-0516
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Fax |
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Provider Business Mailing Address
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Address Line | 804 HAWTHORNE AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-1926
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Country | US
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Telephone | 909-702-1303
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 63588
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License Number State | CA
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