Provider Demographics
NPI:1619409984
Name:SOUBIE, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SOUBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 OLD FAYETTE TRL
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-9740
Mailing Address - Country:US
Mailing Address - Phone:412-622-4812
Mailing Address - Fax:
Practice Address - Street 1:540 OLD FAYETTE TRL
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-9740
Practice Address - Country:US
Practice Address - Phone:412-622-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEO-010666225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant