Provider Demographics
NPI:1538324686
Name:SULFARO-WOLLER, SALLY ANNE (MPT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:SULFARO-WOLLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANNE
Other - Last Name:SULFARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:124 WELTER ROAD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002
Mailing Address - Country:US
Mailing Address - Phone:724-282-4340
Mailing Address - Fax:
Practice Address - Street 1:2757 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3138
Practice Address - Country:US
Practice Address - Phone:724-337-6522
Practice Address - Fax:724-337-0630
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001448340OtherHIGHMARK
PA1011309240004OtherDEPARTMENT OF PUBLIC WELFARE