Provider Demographics
NPI:1104378843
Name:LAGAZ, SARAH (ATC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:LAGAZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HOMBERG AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3738
Mailing Address - Country:US
Mailing Address - Phone:410-271-7106
Mailing Address - Fax:
Practice Address - Street 1:3400 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2608
Practice Address - Country:US
Practice Address - Phone:410-516-5854
Practice Address - Fax:410-516-6440
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00005442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer