Provider Demographics
NPI:1548664659
Name:TRAN, SARA ASHLEE (LMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEE
Last Name:TRAN
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 1:324 MOORE DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4610
Mailing Address - Country:US
Mailing Address - Phone:850-819-1924
Mailing Address - Fax:
Practice Address - Street 1:508 AIRPORT RD STE F
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4025
Practice Address - Country:US
Practice Address - Phone:850-819-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist