Provider Demographics
NPI:1346207800
Name:SAKAYAN, ARA (PT)
Entity Type:Individual
Prefix:MR
First Name:ARA
Middle Name:
Last Name:SAKAYAN
Suffix:
Gender:M
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:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-5068
Mailing Address - Country:US
Mailing Address - Phone:781-631-8998
Mailing Address - Fax:
Practice Address - Street 1:14 BESSOM ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2329
Practice Address - Country:US
Practice Address - Phone:617-523-1701
Practice Address - Fax:617-523-3063
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3103225100000X
MA432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65097Medicare ID - Type Unspecified