Provider Demographics
NPI:1639945967
Name:PAULSON, SARAH ALICIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ALICIA
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ALICIA
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:224 W D. L. INGRAM AVENUE
Mailing Address - Street 2:BLDG. 1408
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:575-904-4025
Mailing Address - Fax:
Practice Address - Street 1:224 W D. L. INGRAM AVENUE
Practice Address - Street 2:BLDG. 1408
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-784-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT6043225100000X
FLPT33859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist