Provider Demographics
NPI:1053652107
Name:SARGENT, SALLY (PT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:KENDREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11312 US 15 501 N
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-6375
Mailing Address - Country:US
Mailing Address - Phone:919-933-1110
Mailing Address - Fax:919-933-1150
Practice Address - Street 1:11312 US 15 501 N
Practice Address - Street 2:SUITE 403
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-6375
Practice Address - Country:US
Practice Address - Phone:919-933-1110
Practice Address - Fax:919-933-1150
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist