Provider Demographics
NPI:1417402272
Name:TELLER, SARAH CVETA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CVETA
Last Name:TELLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:CVETA
Other - Last Name:PAYICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2090 WOODWINDS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2522
Mailing Address - Country:US
Mailing Address - Phone:651-968-5600
Mailing Address - Fax:
Practice Address - Street 1:2090 WOODWINDS DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-968-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16306225100000X
MN11376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist