Provider Demographics
NPI:1568784460
Name:GAW, SARAH SHARON (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:SHARON
Last Name:GAW
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 BEECHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6415
Mailing Address - Country:US
Mailing Address - Phone:719-494-6446
Mailing Address - Fax:
Practice Address - Street 1:125 N PARKSIDE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6097
Practice Address - Country:US
Practice Address - Phone:719-577-9190
Practice Address - Fax:719-785-3798
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist