Provider Demographics
NPI:1467003822
Name:WALLEY, SARAH JANE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:WALLEY
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 HAAG PL APT A
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-3328
Mailing Address - Country:US
Mailing Address - Phone:601-347-0780
Mailing Address - Fax:
Practice Address - Street 1:800 E MCNEESE STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607
Practice Address - Country:US
Practice Address - Phone:337-475-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3209052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer