Provider Demographics
NPI:1437404977
Name:COGGER, SARA FREDERICKSON (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:FREDERICKSON
Last Name:COGGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JEAN
Other - Last Name:FREDERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:109 COURT AVE S
Mailing Address - Street 2:ESSENTIA HEALTH SANDSTONE
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-5120
Mailing Address - Country:US
Mailing Address - Phone:320-245-2211
Mailing Address - Fax:
Practice Address - Street 1:109 COURT AVE S
Practice Address - Street 2:ESSENTIA HEALTH SANDSTONE
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5120
Practice Address - Country:US
Practice Address - Phone:320-245-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist