Provider Demographics
NPI:1659772507
Name:NORDER, SARA ELISABETH (LPTA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELISABETH
Last Name:NORDER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SUMMIT WAY SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5155
Mailing Address - Country:US
Mailing Address - Phone:540-206-2273
Mailing Address - Fax:
Practice Address - Street 1:131 SUMMIT WAY SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5155
Practice Address - Country:US
Practice Address - Phone:540-206-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602847225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant