Provider Demographics
NPI:1467550822
Name:MCCLOUD, SARAH ANN (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 S WAKEA AVE.
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732
Mailing Address - Country:US
Mailing Address - Phone:360-289-0251
Mailing Address - Fax:360-289-3226
Practice Address - Street 1:161 S WAKEA AVE.
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:360-532-0544
Practice Address - Fax:360-532-0559
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010021225100000X
HIPT3603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8446239Medicaid
WA8446239Medicaid
Q66582Medicare UPIN
WAG8859359Medicare PIN