Provider Demographics
NPI:1366843641
Name:COPLIN, SARAH (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:
Last Name:COPLIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BYRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:738 29TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3151
Mailing Address - Country:US
Mailing Address - Phone:218-791-1458
Mailing Address - Fax:
Practice Address - Street 1:4420 37TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-3400
Practice Address - Country:US
Practice Address - Phone:218-791-1458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11163PT2251P0200X
MN9645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics