Provider Demographics
NPI:1104450758
Name:DIGRE, SARAH ANDERSON (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANDERSON
Last Name:DIGRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1453 W BERING DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8399
Mailing Address - Country:US
Mailing Address - Phone:801-386-6264
Mailing Address - Fax:208-684-7834
Practice Address - Street 1:9751 N GOVERNMENT WAY STE 4
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9645
Practice Address - Country:US
Practice Address - Phone:208-696-1300
Practice Address - Fax:208-684-7834
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDMAS-1292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1033754791OtherOFFICE