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General NPI Number Information
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NPI Number | 1952700056
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Entity Type | Organization
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Legal Business Name | SARA SAMPSON
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 3534 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9054
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Country | US
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Telephone | 304-389-8970
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Fax |
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Provider Business Mailing Address
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Address Line | 2815 28TH ST
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City | NITRO
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State | WV
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Zip | 25143-1620
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Country | US
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Telephone | 304-389-8970
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARA SAMPSON
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Credential | LMT
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Telephone | 304-389-8970
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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 | 2005-1891
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License Number State | WV
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