Provider Demographics
NPI:1518082890
Name:FENTER, SARA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:FENTER
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 1:101 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3805
Mailing Address - Country:US
Mailing Address - Phone:870-629-9413
Mailing Address - Fax:
Practice Address - Street 1:101 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3805
Practice Address - Country:US
Practice Address - Phone:870-629-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A452Medicare PIN