Provider Demographics
NPI:1790975761
Name:KELLY, SARAH SHAW (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:SHAW
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 VIRGIL ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7470
Mailing Address - Country:US
Mailing Address - Phone:303-978-9396
Mailing Address - Fax:
Practice Address - Street 1:6080 VIRGIL ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80403-7470
Practice Address - Country:US
Practice Address - Phone:303-978-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4963171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4963OtherPHYSICAL THERAPIST