Provider Demographics
NPI:1528235983
Name:BOAZ, SARA L (LMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:BOAZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:VAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:30789 SW BOONES FERRY RD STE P
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30789 SW BOONES FERRY RD
Practice Address - Street 2:STE P
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7842
Practice Address - Country:US
Practice Address - Phone:503-682-6778
Practice Address - Fax:503-682-6744
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7115225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist