Provider Demographics
NPI:1316561319
Name:ANDERSON, SARAH E (MED, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-3903
Mailing Address - Country:US
Mailing Address - Phone:830-372-5770
Mailing Address - Fax:
Practice Address - Street 1:1315 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3903
Practice Address - Country:US
Practice Address - Phone:830-372-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
TXAT19732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer