Provider Demographics
NPI:1861800575
Name:SAGI, HIROYO
Entity type:Individual
Prefix:
First Name:HIROYO
Middle Name:
Last Name:SAGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26175 RAMBLING LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-7567
Mailing Address - Country:US
Mailing Address - Phone:573-433-9151
Mailing Address - Fax:
Practice Address - Street 1:105 BOSA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ST, ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584
Practice Address - Country:US
Practice Address - Phone:573-433-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012009769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist