Provider Demographics
NPI:1366857435
Name:DRAGOSZ, SARA E (ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:DRAGOSZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 N LOOP 289 SUITE 101
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2422
Mailing Address - Country:US
Mailing Address - Phone:806-797-4985
Mailing Address - Fax:
Practice Address - Street 1:4642 N LOOP 289 SUITE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2422
Practice Address - Country:US
Practice Address - Phone:806-797-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer