Provider Demographics
NPI:1730616350
Name:SMITH, SARAH LYNN (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:SMITH
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 1:611 S HIGHWAY 78
Mailing Address - Street 2:104
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4081
Mailing Address - Country:US
Mailing Address - Phone:214-586-2376
Mailing Address - Fax:
Practice Address - Street 1:611 S HIGHWAY 78
Practice Address - Street 2:104
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4081
Practice Address - Country:US
Practice Address - Phone:214-586-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist