Provider Demographics
NPI:1053787093
Name:ORTH, SARA (CMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ORTH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0521
Mailing Address - Country:US
Mailing Address - Phone:320-493-0233
Mailing Address - Fax:815-550-2346
Practice Address - Street 1:203 COOPER AVE N
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4446
Practice Address - Country:US
Practice Address - Phone:320-493-0233
Practice Address - Fax:815-550-2346
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist