Provider Demographics
NPI:1285365460
Name:SAUTNER, REBECCA ANNE (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:SAUTNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16674 N 91ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2761
Mailing Address - Country:US
Mailing Address - Phone:480-454-8635
Mailing Address - Fax:
Practice Address - Street 1:16674 N 91ST ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2761
Practice Address - Country:US
Practice Address - Phone:480-410-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172M00000X
AZMT-05756P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177607874OtherMASSAGE THERAPY