Provider Demographics
NPI:1467525113
Name:TREADWELL, SARA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:R
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53-59 PUBLIC SQUARE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2603
Mailing Address - Country:US
Mailing Address - Phone:315-782-7872
Mailing Address - Fax:315-782-7871
Practice Address - Street 1:53-59 PUBLIC SQUARE
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2603
Practice Address - Country:US
Practice Address - Phone:315-782-7872
Practice Address - Fax:315-782-7871
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034971225200000X
NY003497-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD04505Medicare UPIN
NY56468AMedicare ID - Type Unspecified
P81152Medicare UPIN