Provider Demographics
NPI:1073600235
Name:SARA ELLERBE PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:SARA ELLERBE PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-795-8023
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2536
Mailing Address - Country:US
Mailing Address - Phone:626-795-8023
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE STE 105
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:626-795-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7858AMedicare PIN