Provider Demographics
NPI:1508172388
Name:PELLEGREEN, SARA (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:PELLEGREEN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HWY 407
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2124
Mailing Address - Country:US
Mailing Address - Phone:972-317-7775
Mailing Address - Fax:972-317-6356
Practice Address - Street 1:1301 HWY 407
Practice Address - Street 2:SUITE 206
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2124
Practice Address - Country:US
Practice Address - Phone:972-317-7775
Practice Address - Fax:972-317-6356
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10551502251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics