Provider Demographics
NPI:1437548781
Name:AMAKHTARI, SARAH (ATC)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:
Last Name:AMAKHTARI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W COLORADO BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2859
Mailing Address - Country:US
Mailing Address - Phone:626-833-1284
Mailing Address - Fax:
Practice Address - Street 1:2113 W PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2031
Practice Address - Country:US
Practice Address - Phone:626-833-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer