Provider Demographics
NPI:1700843794
Name:WHITESIDE, SARA (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:GERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:VA
Mailing Address - Zip Code:22972-0013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 SELMA RD
Practice Address - Street 2:HORNET FIELD HOUSE
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1821
Practice Address - Country:US
Practice Address - Phone:540-661-4300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260006172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer