Provider Demographics
NPI:1992284541
Name:VENNES, SARAH (MT, CNMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VENNES
Suffix:
Gender:F
Credentials:MT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FLYING CLOUD DR STE 240
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3326
Mailing Address - Country:US
Mailing Address - Phone:952-412-8727
Mailing Address - Fax:
Practice Address - Street 1:6400 FLYING CLOUD DR, SUITE 240
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:952-412-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1338393OtherAMTA