Provider Demographics
NPI:1003485566
Name:SAMPLE, SARAH (ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 FOREST XING
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7004
Mailing Address - Country:US
Mailing Address - Phone:814-790-2902
Mailing Address - Fax:
Practice Address - Street 1:17 MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1436
Practice Address - Country:US
Practice Address - Phone:609-686-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer