Provider Demographics
NPI:1235694878
Name:BAREMORE, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BAREMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 1850
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:MO
Mailing Address - Zip Code:63662-9719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 1850
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:MO
Practice Address - Zip Code:63662-9719
Practice Address - Country:US
Practice Address - Phone:573-576-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019001722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant