Provider Demographics
NPI:1245425990
Name:REARDON, SARA C (DPT)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:C
Last Name:REARDON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 BARONNE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5377
Mailing Address - Country:US
Mailing Address - Phone:504-814-3615
Mailing Address - Fax:504-270-1925
Practice Address - Street 1:3915 BARONNE ST STE 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5377
Practice Address - Country:US
Practice Address - Phone:504-814-3615
Practice Address - Fax:504-270-1925
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1177980225100000X
LA09734R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1245425990Medicaid