Provider Demographics
NPI:1891868584
Name:JOLLY, SARAH JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEAN
Last Name:JOLLY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:JOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7162 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9409
Mailing Address - Country:US
Mailing Address - Phone:913-962-7770
Mailing Address - Fax:913-962-7775
Practice Address - Street 1:7162 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9409
Practice Address - Country:US
Practice Address - Phone:913-962-7770
Practice Address - Fax:913-962-7775
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006032140225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant