Provider Demographics
NPI:1407210743
Name:HARRY, SARA (BS, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:HARRY
Suffix:
Gender:F
Credentials:BS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SADDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9411
Mailing Address - Country:US
Mailing Address - Phone:317-529-0642
Mailing Address - Fax:
Practice Address - Street 1:201A SUMMER TREE CIR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-5994
Practice Address - Country:US
Practice Address - Phone:317-529-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60272255A2300X
IN36002278A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer