Provider Demographics
NPI:1699264788
Name:STETSON, SARAH (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STETSON
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 1:10848 169TH RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6248
Mailing Address - Country:US
Mailing Address - Phone:386-249-5319
Mailing Address - Fax:
Practice Address - Street 1:405 11TH ST SW STE 206
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3162
Practice Address - Country:US
Practice Address - Phone:386-249-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist