Provider Demographics
NPI:1497836787
Name:DOMINGUEZ, SARAH B (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:B
Last Name:DOMINGUEZ
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 1:601 E 63RD ST STE 230
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3303
Mailing Address - Country:US
Mailing Address - Phone:816-569-2802
Mailing Address - Fax:816-569-5436
Practice Address - Street 1:601 E 63RD ST STE 230
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3303
Practice Address - Country:US
Practice Address - Phone:816-569-2802
Practice Address - Fax:816-569-5436
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003007571225100000X
KS11-03922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2861001Medicare UPIN