Provider Demographics
NPI:1013734276
Name:O'CONNOR, SARA ANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HEMPHILL PL STE 130
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4482
Mailing Address - Country:US
Mailing Address - Phone:518-289-5242
Mailing Address - Fax:
Practice Address - Street 1:7 HEMPHILL PL STE 130
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4482
Practice Address - Country:US
Practice Address - Phone:518-289-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist