Provider Demographics
NPI:1689033714
Name:SUDHEIMER, SARAH EDWARDS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:EDWARDS
Last Name:SUDHEIMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MENENDEZ RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5328
Mailing Address - Country:US
Mailing Address - Phone:757-353-7500
Mailing Address - Fax:
Practice Address - Street 1:1720 A1A S UNIT E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5547
Practice Address - Country:US
Practice Address - Phone:904-799-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012271225100000X
FLPT323882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist