Provider Demographics
NPI:1154441442
Name:FARIS, SARA E (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:FARIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9258 STONEBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6427
Mailing Address - Country:US
Mailing Address - Phone:440-327-2081
Mailing Address - Fax:
Practice Address - Street 1:12221 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5029
Practice Address - Country:US
Practice Address - Phone:216-221-2525
Practice Address - Fax:216-221-2506
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA4206291OtherMEDICARE PTAN