Provider Demographics
NPI:1144511551
Name:SAWYER, THERESA ANNE (LMT, MMP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:SAWYER
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05472-3108
Mailing Address - Country:US
Mailing Address - Phone:802-989-8704
Mailing Address - Fax:
Practice Address - Street 1:1077 SAWYER RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:VT
Practice Address - Zip Code:05472-3108
Practice Address - Country:US
Practice Address - Phone:802-989-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT#111760225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist