Provider Demographics
NPI:1659588143
Name:DORMOIS, SARAH BURTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BURTON
Last Name:DORMOIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 BRYN MAWR COVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-758-8066
Mailing Address - Fax:
Practice Address - Street 1:1789 KIRBY PKWY
Practice Address - Street 2:SUITE #3
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3608
Practice Address - Country:US
Practice Address - Phone:901-759-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446575Medicaid
TN446575Medicare ID - Type Unspecified