Provider Demographics
NPI:1588833321
Name:WILLETT, SARAH MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-2638
Mailing Address - Country:US
Mailing Address - Phone:805-473-7499
Mailing Address - Fax:805-473-7494
Practice Address - Street 1:271 FIVE CITIES DR
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3009
Practice Address - Country:US
Practice Address - Phone:805-473-7499
Practice Address - Fax:805-473-7494
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT343840OtherBLUE SHIELD OF CALIFORNIA
CA0PT343840OtherBLUE SHIELD OF CALIFORNIA
CAOPT343841Medicare PIN
CA0PT343841Medicare PIN