Provider Demographics
NPI:1184674467
Name:SEITZ, SARA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:SEITZ
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 1:525 MELISSA AVE
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3002
Mailing Address - Country:US
Mailing Address - Phone:760-256-1888
Mailing Address - Fax:760-244-4288
Practice Address - Street 1:525 MELISSA AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3002
Practice Address - Country:US
Practice Address - Phone:760-256-1888
Practice Address - Fax:760-244-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQO8814Medicare ID - Type Unspecified