Provider Demographics
NPI:1144564154
Name:BRANDT, SARAH DIANE (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DIANE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DIANE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2130 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4552
Mailing Address - Country:US
Mailing Address - Phone:314-814-1887
Mailing Address - Fax:
Practice Address - Street 1:2130 HICKORY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-4552
Practice Address - Country:US
Practice Address - Phone:314-814-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist