Provider Demographics
NPI:1114652955
Name:BOETTNER, SARAH (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BOETTNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 PLANTATION ST APT 316
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-4341
Mailing Address - Country:US
Mailing Address - Phone:845-661-0980
Mailing Address - Fax:
Practice Address - Street 1:120 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1457
Practice Address - Country:US
Practice Address - Phone:508-859-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist