Provider Demographics
NPI:1346535366
Name:LANDGRAVE, SARA (PT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:LANDGRAVE
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 1:290 NICKEL ST 200
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2183
Mailing Address - Country:US
Mailing Address - Phone:303-460-9339
Mailing Address - Fax:
Practice Address - Street 1:10355 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80247-3622
Practice Address - Country:US
Practice Address - Phone:303-755-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist