Provider Demographics
NPI:1154743706
Name:SAX, MISTY ANNE (MS,LAT,ATC)
Entity type:Individual
Prefix:MISS
First Name:MISTY
Middle Name:ANNE
Last Name:SAX
Suffix:
Gender:F
Credentials:MS,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RAIN WATER WAY
Mailing Address - Street 2:UNIT 301
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-3247
Mailing Address - Country:US
Mailing Address - Phone:703-624-2289
Mailing Address - Fax:410-777-2233
Practice Address - Street 1:101 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1857
Practice Address - Country:US
Practice Address - Phone:410-777-2323
Practice Address - Fax:410-777-2233
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00003252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer