Provider Demographics
NPI:1508455882
Name:SARGENT, SARAH RUTH (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RUTH
Last Name:SARGENT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2240
Mailing Address - Country:US
Mailing Address - Phone:207-769-2160
Mailing Address - Fax:207-769-2161
Practice Address - Street 1:5 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2240
Practice Address - Country:US
Practice Address - Phone:207-769-2160
Practice Address - Fax:207-769-2161
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA5802225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant