Provider Demographics
NPI:1497496954
Name:SMEDRA, SARA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:SMEDRA
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 1:47091 792ND RD
Mailing Address - Street 2:
Mailing Address - City:LOUP CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68853-5150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:652 N ST
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853-8131
Practice Address - Country:US
Practice Address - Phone:308-380-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist