Provider Demographics
NPI:1083438253
Name:MALMBERG, SADIE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:MARIE
Last Name:MALMBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:OLDBURY
Other - Last Name:MALMBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST STE 501
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3061
Mailing Address - Country:US
Mailing Address - Phone:409-626-1811
Mailing Address - Fax:
Practice Address - Street 1:575 18TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5031
Practice Address - Country:US
Practice Address - Phone:409-626-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT116290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist