Provider Demographics
NPI:1861046450
Name:BABCOCK, SARAH (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3136 N 3350 W
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:ID
Mailing Address - Zip Code:83255-8760
Mailing Address - Country:US
Mailing Address - Phone:208-554-3554
Mailing Address - Fax:
Practice Address - Street 1:260 W GRAND AVE RM 3
Practice Address - Street 2:
Practice Address - City:ARCO
Practice Address - State:ID
Practice Address - Zip Code:83213-4906
Practice Address - Country:US
Practice Address - Phone:208-313-8418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist