Provider Demographics
NPI:1558010678
Name:VAN DEMAN, SARA (PTA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VAN DEMAN
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 1:826 CYPRESS W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3023
Mailing Address - Country:US
Mailing Address - Phone:317-832-3353
Mailing Address - Fax:
Practice Address - Street 1:826 CYPRESS W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3023
Practice Address - Country:US
Practice Address - Phone:317-832-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005569A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant