Provider Demographics
NPI:1760510341
Name:PAGE, SARAH ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELLEN
Last Name:PAGE
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 1:74 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6455
Mailing Address - Country:US
Mailing Address - Phone:802-257-5055
Mailing Address - Fax:802-257-5055
Practice Address - Street 1:74 BROOK ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6455
Practice Address - Country:US
Practice Address - Phone:802-257-5055
Practice Address - Fax:802-257-5055
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2160Medicaid
VTOVN2160Medicaid