Provider Demographics
NPI:1942684394
Name:EARNEST, SARAH ROSE (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:EARNEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:MICHALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:101 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1327
Mailing Address - Country:US
Mailing Address - Phone:520-432-5383
Mailing Address - Fax:
Practice Address - Street 1:815 E 15TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1631
Practice Address - Country:US
Practice Address - Phone:520-364-5437
Practice Address - Fax:520-515-8663
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist