Provider Demographics
NPI:1598026502
Name:EADS, SARAH RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RENEE
Last Name:EADS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RENEE
Other - Last Name:IDRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4730 SHAVANO OAK STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4029
Mailing Address - Country:US
Mailing Address - Phone:210-526-2428
Mailing Address - Fax:210-561-7121
Practice Address - Street 1:4730 SHAVANO OAK STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4029
Practice Address - Country:US
Practice Address - Phone:210-526-2428
Practice Address - Fax:210-817-8684
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218209225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX878T09OtherBCBS
TX304772201Medicaid
TX12397091OtherCAQH
TXP01117442Medicare PIN
TXTXB158247Medicare PIN