Provider Demographics
NPI:1174831499
Name:SUDDARTH, SARAH DEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DEE
Last Name:SUDDARTH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:SUDDARTH
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2842 TACKETS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:TN
Mailing Address - Zip Code:38477-6717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1816 HUNTSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3787
Practice Address - Country:US
Practice Address - Phone:931-228-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7960225100000X
TN8744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist