Provider Demographics
NPI:1376537274
Name:HARWELL, SARAH NICHOL (PT DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICHOL
Last Name:HARWELL
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 W ANTHEM WAY
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0455
Mailing Address - Country:US
Mailing Address - Phone:623-551-9706
Mailing Address - Fax:
Practice Address - Street 1:3345 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7330
Practice Address - Country:US
Practice Address - Phone:480-857-7123
Practice Address - Fax:480-857-8250
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107899Medicare PIN