Provider Demographics
NPI:1407915127
Name:SCHRADER, SARA (MSPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1452
Mailing Address - Country:US
Mailing Address - Phone:585-414-0065
Mailing Address - Fax:
Practice Address - Street 1:60 BARRETT DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2963
Practice Address - Country:US
Practice Address - Phone:585-872-7977
Practice Address - Fax:585-872-7989
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB3545OtherMEDICARE PTAN
NY28910OtherPT LICENSE NUMBER