Provider Demographics
NPI:1023027273
Name:ATKINSON, SARA J (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 MEDICAL CENTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2752
Mailing Address - Country:US
Mailing Address - Phone:503-364-5313
Mailing Address - Fax:503-364-5296
Practice Address - Street 1:853 MEDICAL CENTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2752
Practice Address - Country:US
Practice Address - Phone:503-364-5313
Practice Address - Fax:503-364-5296
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR137887Medicare PIN
MN650001418Medicare ID - Type Unspecified
MNP00333411Medicare ID - Type UnspecifiedRAILROAD